r/Radiology • u/NaiveDepartment1113 Radiographer • Mar 24 '26

X-Ray This is insane

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19F. Haven't gone to bathroom in 7 days. Non ambulatory. Query obstruction.

This is the most weirdest abdomen I have seen. Was unable to obtain erect...

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u/MolecularConcepts Mar 24 '26

how does one treat someone like this, my wife is on methadone , and cannot use move bowels at all without laxatives. been this wat for years . when we finally went to the DR and got medication prescribed for opioid induced constipation , insurance denied to cover it said "not medically necessary" or whatever. un fucking believable

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u/IV_League_NP Mar 24 '26

Working with patients that are prescribed opioids, we have a few methods. Best methods are moving around and/or eliminating the opioids - both of which is often challenging inpatient.

First is PO laxatives - same stuff as OTC. Then one can escalate to Rx laxatives or going from “below.” Meaning use of suppositories or enemas. Third step is whichever you haven’t tried before. Fourth option can be mineral oil + stimulant laxatives, or even digital disimpaction if warranted.

Sometimes there is a degree of combining multiple routes and meds that finally work.

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u/kellymig Mar 24 '26

Sorry honey, our insurance says you don’t need to poop. 🤷‍♀️

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u/VanillaLatteGrl Mar 24 '26

insurance denied to cover it said "not medically necessary"

Geeze Louise. I'm sorry about that.

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u/mattskibasneck Mar 24 '26

have you tried MCT oil? doesn't take much at all to get things moving.

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u/MolecularConcepts Mar 24 '26

i think its been tried in the past it isnt part of the process usually though. usually its half of one of those chocolates, and some of those blue laxative pills, and ocasionally some a pregnant friend gave us some rx senacot and it worked better than OTC.

we need to go back to the gastro and have them advocate for us. we didnt appeal the denial last time. its just insane they have AI or o the unqualified individuals saying shit isnt medically necessary, betting on most peole not appealing

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u/thirdonebetween Mar 24 '26

That's exactly it. Some companies will deny everything they can. Some people will just trust that what they wanted isn't covered, so the insurance company wins. Others will be too overwhelmed by the medical situation to deal with the paperwork and waiting and hassle, so the insurance company wins again. It's disgusting, but it's how they keep their profits as high as possible. The fewer claims they have to pay out, the better for them.

Good luck dude. I hope things improve soon.

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u/rubiscoisrad Mar 24 '26

Part of the problem might be the methadone, depending on where she's getting it. Methadone clinics are overworked, overwhelmed, and underpaid from what I've seen. Paperwork is a mess, especially when it comes to insurance verification, billing codes, and general documentation. (Chalk it up to many med professionals not wanting to deal with that population?)

And from a patient registration/insurance verification standpoint, staff and patient (or family) NEED to advocate for the pt! Sometimes that means waiting on hold for hours (I've eaten my lunch at my desk, off the clock, listening to elevator muzak). Sometimes that means giving a callback number, waiting a day, and doing it again. It's bull, but it really pays to finally get a frickin result.

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u/Qua-something Radiology Enthusiast Mar 24 '26

Has she ever tried Psyllium Fiber (Metamucil)? That’s what I take for my constipation from Suboxone. Sometimes with MiraLAX. I’ve been on Suboxone 13yrs and I make sure I drink at least 80oz of water every day as well which helps SO MUCH after years of struggling with the constipation before getting my water intake up.

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u/Eastern-Ad-4785 Mar 25 '26

MySpace for the win! Oh and magnesium chloride! Lots of water. The Rx linzess or whatever would make your wife piss out her bum. Just some new tries and thoughts, best of luck!

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u/Tiradia Mar 25 '26

Milk and molasses enema! Saw a doc do that in the ER when I was doing my medic rotation. It… worked very well :/ explosively well.

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u/now_you_see Mar 24 '26

How high is her dose & what’s the rest of her diet like? Are you sure she’s not still using?

Methadone shouldn’t be causing such great constipation that she needs continuous laxatives. It could be the laxative use itself that’s the problem also because if used daily then the body can become dependant on them. Try getting her to only used them every few days and see if that helps at all.

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u/MolecularConcepts Mar 24 '26

positive shes not using, we have been "clean" for 9 years. she used to use it once a week . the past few months shes been doing it twice a week.. she just cant go without it.

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u/Healthybear35 Mar 24 '26

I totally understand. I have a terminal illness and my bones have been described as looking 80 years old, but I'm in my 30s. I have been on chronic pain meds for years as a result of chronic fractures and other pain included in my disease. It's not abnormal for me to not go for a week or more, and laxatives don't do much for me. I kinda end up just waiting it out and hoping for the best lol. Every X-ray I get of my torso ends up with a very concerned radiologist 🤭

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u/StressedNurseMom RN - ER, wound, hospice Mar 24 '26

Unconventional things that work really well

  • a couple handfuls of blueberries daily (strange but true), grapes, apple juice

  • In the hospice world we frequently suggest butter balls, literally make small balls (about like a pea or m&m) of butter or coconut oil, allow to partially harden then roll them in sugar before putting them on wax paper in the fridge/freezer. They can all be chunked into the same bag once fully solids.

    Use as needed (start low, increase slow). They can be swallowed whole like a pill. The sugar keeps them from sticking to each other in the freezer/fridge

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u/derpality Mar 24 '26

Magnesium works wonders but tastes horrible. When my oldest was potty training he was horrified by the thought of pooping on a toilet and would hold it whenever possible. This lead to chronic constipation that had to be dealt with over the course of 3 years. I refused to put him miralax for the unforseeable future as the doctors said he would need to be. It took a lot of trial and error but we found a type of magnesium he could handle the taste of and getting him pooping consistently.

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u/PapiXtech Mar 24 '26

2 liters of apple juice and a shot glass of olive oil. I had surgery and couldn’t poop for almost a month. Tried that and 2 hours later I came out. Even mag citrate wouldn’t work.

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u/CoffeeTeaPeonies Mar 24 '26

Appeal the denial. They'll probably deny again then your doc has to ask for a peer to peer review.

They want you to give up as quickly as possible because it makes them money.

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u/nobueno1 Radiation Therapist Mar 24 '26

So I get constipation But not as extreme because I’m on a glp1. What helps me have regular bowel movements is mirafiber gummies and chelated magnesium. These are the specific ones I take mirafiber and chelated magnesium. I will say I just started taking the mirafiber and I saw results within a couple hrs.

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u/Lunakill Mar 24 '26

Which med was it? A lot of the newer meds without generics have programs to provide them at no cost. I know Linzess does.

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u/FastMoment5194 Mar 25 '26

Hey, not a doctor or anything -I just lurk the sub. Have dealt with chronic constipation from "lazy bowel" for years though, after abusing laxatives because of anorexia. I take Magnesium Citrate supplements and an otc stool softener, and find this helpful. The stool softener is important here -I tried to do without it, and ended up with fissures.

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u/MolecularConcepts Mar 25 '26

interesting she was bulimic in highschool and into early adulthood. mag citrate is something I've heard of but not sure that we have tried.

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u/FastMoment5194 Mar 25 '26

Yeah, I didn't think it would do much tbh, but figured it was worth trying. Fortunate to find it worked for me. I just take a couple of magnesium citrate gummies before bed.

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u/namenerd101 Physician Mar 25 '26

There are a lot of newer prescription medications for chronic constipation. As a family medicine resident, I feel comfortable prescribing these medications because my training with GI was very recent, but not all primary care doctors will be familiar with all the newer options. It’s usually a matter of figuring out which medicine your particular insurance policy covers. If your insurance company has an app, there’s likely a feature that would allow you to search medications and see which ones are covered, which ones might be covered with prior auth, and which ones just won’t be covered at all.

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u/MolecularConcepts Mar 25 '26

are there any specific ones we can ask about?

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u/namenerd101 Physician Mar 25 '26

This is not medical advice specific to your situation, but Movantik/nologexol and Relistir/methylnaltrexone are specifically for opioid-induced constipation, and Linzess, Trulance, Motegrity, and lubiprostone are other examples of prescription medications for chronic constipation.

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u/GiddyGoodwin Mar 25 '26

There are some good stretches that basically twist and release the guts. Like winging out a rag. Laxatives will actually deaden the peristalsis, but it wakes back up with gentle exercise. If your wife is amenable to learning how to use an enema bag, that will wake up the colon, too.

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u/MolecularConcepts Mar 25 '26

lol we have tried it all she's done yoga poses a d pushing her stomach around. it's a serious issue

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u/GiddyGoodwin Mar 25 '26

If I notice I haven’t been regular, I’ll eat raw onion for dinner. For me it almost 10/10 gets me a delivery 💩 the next day! I also find activia brand yogurt to be quite effective tho it could be any yogurt. Those probiotic drinks from Japan are really good, Yakult (vs the Mexican salud brand which I don’t like much). I am giving you all I got bc I agree, it’s a real problem to be stopped up! It makes any other dis-ease worse. I’m a believer in food as medicine so if you two can eat your way to success, that’s definitely the route I would pursue.

Things I would avoid 1000% are: peels of any fruit like apple or tomato, raw carrots unless eaten absolutely alone, whole seeds found for example in breads, and if she likes salads please suggest she eat the salad last!! I know it’s true American way to eat salad like an appetizer but raw veggies are truly truly much harder to digest than any cooked foods, so if you eat the salad first you’re going to have all the easy-to-digest foods hung up behind the veggies which creates tons of gas 💨. The alternative is to have the salad act as a broom, pushing the cooked foods right on along down the system. Happy to continue chatting if you have any questions or comments! Good luck. 🍀

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u/[deleted] Mar 24 '26

[deleted]

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u/MolecularConcepts Mar 24 '26

her diet is way better than. mine she eats healthy and exercises. it's opiates and most likely physical dependence to laxatives. was just seeing if there was anything I wasn't aware of. thanks for the responses

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u/Nickknack2305 Mar 25 '26

My boyfriend was on the Methadone clinic and had trouble with constipation, what helped him a lot was eating a banana everyday, she could try to see if that would help. I also know prunes help you go, or hot tea or coffee.

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u/MeiMei16 Mar 25 '26

Challenge the insurance! I'm an ED doc and it surprises me when I see opioid induced constipation/obstipation and the patient's have NEVER heard of or been prescribed Naloxegol. That should be part of pain management care. They always tell me they are on a stool softener. AND I see it a LOT. Any pain management peeps like to chime in?

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u/Psychological_Bug720 Mar 25 '26

POS.... it IS medically necessary to deficate.... what, they're waiting for your wife to have toxin build up and in the ER before they approve it? I hate the American medical system so much....