tudies show that 47% of people on opioid medications, even very low doses, will experience opioid induced constipation. Constipation is defined as “incomplete, difficult, infrequent evacuation of dry hardened feces from the bowels” and being fewer than three bowel movements per week.
Opioids block pain signals by attaching to receptors throughout the nervous system and in the gut. The effect on the gastrointestinal system is a slowing in the amount of time it takes stool to pass through the system.
- When your loved one gets a prescription for opioids, that is the time to discuss constipation with your physician and what to expect; what is or is not normal.
- Let your physician know what your loved one’s current bowel habits are as this will establish a baseline to compare with any later concerns and to set realistic goals. If the current norm is a BM every other day, it is unrealistic to expect one every day while taking opioid medications.
- Go over all medications (prescription and over-the-counter), vitamins, and herbal supplements being taken as some can cause constipation on their own; with the addition of opioids, that condition is made worse.
- Call your physician immediately if there is rectal bleeding, intense abdominal pain, nausea, vomiting and unplanned weight loss. These symptoms could indicate a blockage that could be life threatening.
Over-the-counter (OTC) Medications
These common remedies can be purchased at your local pharmacy.
These increase the amount of water in the colon and help make stool passage easier.
- ducasate (Colace)
- lubricants (mineral oil)
Help fluid move through the colon.
- polyethylene glycol (Miralax)
- magnesium hydroxide (Milk of Magnesia)
These increase intestinal contractions to move things along.
- biscadyl (Dulcolax)
- senna – sennosides (Senekot)
Enemas or suppositories
Soften stools and stimulate bowel activity.
The medication used in hospitals to relieve constipation quickly is now available in tablet form through a prescription from your physician. These medications stop opioids from attaching to receptors in the gut while not affecting those receptors in the brain.
- naloxegol (Movantik)
- methylnatrexone (Relistor)
Be aware that they could possibly interfere with an opioid medication’s efficacy and may have additional side effects.
Discuss with your physician if these natural products are an option for your loved one’s prevention and treatment plan for constipation.
Increase water absorption in the colon to form bulkier stools and helps them pass easier. It is important to drink plenty of fluids while taking a fiber supplement. Dehydration can occur making the opioid-induced constipation worse and fecal impaction possible. It can also decrease the absorption of some medications, including aspirin.
- psyllium (Metamucil)
- methycellulose (Citrucel)
This natural liquid improves intestinal mobility and fecal volume. It may decrease the effectiveness of certain medications such as cholesterol-lowering drugs, anti-inflammatories and hormonal drugs.
This flowering plant’s leaves have a laxative effect. It is available in capsules, tablet form and as a tea. It should only be taken for a short time. Long-term use increases the risk of bleeding from certain medications.
- blood thinners – warfarin (Coumadin)
- NSAIDS – ibuprophen (Advil) and naproxen sodium (Aleve)
Tips on prevention and early treatment
- Increase fluid intake. Water is the best source of hydration. Decrease caffeine drinks as they can actually remove fluids.
- Increase dietary fiber. This includes fruits, vegetables and cereals. Some supplements containing psyllium and methylcellulose will add bulk to the stool and help retain water.
- Exercise. But always check with your physician before starting any new exercise or physical activity.
- Ice/hot therapy for any bloating or abdominal pain. Place a warm or cold compress on the pelvic area.
PracticalPainManagement.com, December 2016, Opioid-induced Constipation: New and Emerging Therapies – Update 2016, By Jeffrey Gudin, MD
Pain-Free Living, February/March 2017; 45-47. Opioids and Your Gut: Why Constipation Often Follows Opioid Use and What You Can Do About It by Kurt Ullman