While some people rely on opioids to reduce their pain and give them a chance at a semi-normal life, these medications come with their own host of side effects. Beyond the dangerous effects of abuse and increased tolerance, they also cause opioid induced constipation (OIC for short). If you take opioids, it’s almost guaranteed that you’ll suffer from constipation at one point or another. Here’s why, and more importantly, how to treat and manage it.
What is opioid induced constipation?
As Abraham J. Kabazie, MD, explains for the American Chronic Pain Association, “Almost everyone that starts on opioids, and is on opioids for chronic pain for any period of time, will develop some sort of constipation.”
According to patient surveys, as many as 90% of patients experience opioid induced constipation during their treatment. This number may actually be higher, due to the reserve many people have about discussing bowel movements. Talking about your constipation to your doctor is important, though. It can be the best way to treat and prevent it from occurring in the future.
Opioid induced constipation occurs specifically because of the way both opioids and your GI tract function. Simply put, the very reason opioids help reduce your pain is the very same reason constipation occurs.
Opioids can help reduce your pain by attaching to receptors in the central nervous system. Once there, they send signals to “block” pain. They also have a calming effect that can lead to slowed breathing. Unfortunately, these same messages are the same that help control functions in our GI tract. Opioid use can:
- Slow down peristalsis, the wave-like function that moves solids through your digestive tract
- Tighten up the sphincter muscles in your gut
- Reduce fluid and lubricant inside the bowels, leading to hard stools or stool that adheres to the bowel wall
- Dampen your urge to “go” to the restroom
Opioid induced constipation symptoms
The symptoms of opioid induced constipation don’t differ from those of typical constipation, except that they occur with opioid use and can be harder to treat.
- Hard, lumpy, or dry stools
- Abdominal pain or cramping
- Inability to empty bowels completely, or feeling like you still need to go after
- Feeling a blockage in the intestine or rectum
- Straining or pain with defecation
- Passing fewer than three stools a week
Risks of opioid induced constipation
If you’ve suffered from constipation, you know how it can affect your everyday life. It isn’t simply being able to go to the restroom–it’s constant pain during the day and while trying to defecate.
Opioid induced constipation comes with a number of further risks beyond discomfort. These include:
- Skipping or reducing medication, leading to more pain
- Bowel obstruction
- Fecal impaction that can lead to colonic necrosis
Constipation risks like fecal impaction are treatable, if you get treatment for them. Refusing to talk to a doctor about your constipation could lead to worsening of symptoms, infection, or even death.
How can I prevent or manage opioid induced constipation?
Prevention starts at the beginning. Before you start taking opioids to manage pain, talk to your doctor about your risk for constipation. This conversation may feel uncomfortable, but it is absolutely necessary for you to avoid risks and reduce abdominal pain in the future. As MPR explains:
“Constipation is multi-factorial. Many patients have risk factors for constipation before they begin taking opioids—the drugs just magnify an existing problem. These risk factors may be related to a poor diet, a lack of exercise or low fluid intake.”
Your doctor will be able to discuss those risk factors with you and suggest preventative treatments. More importantly, it starts a dialogue between you and your doctor about your bowel movements. Your doctor’s primary concern is your care. They can’t provide that level of care unless they know exactly what symptoms you’re experiencing, both at the beginning and throughout your treatment plan. This is the best way to prevent and find opioid constipation relief.
Incorporate opioid constipation home remedies into your routine
One of the first things your doctor will advise on is your current lifestyle factors. To prevent opioid induced constipation, you have to:
- Increase your fiber intake, with fruits, veggies, and whole grains, to meet the recommended intake of 25 to 38g per day
- Drink plenty of water, especially during seasonal changes or changes in exercise
- Avoid fatty, processed meats, fast food, and processed snacks
- Incorporate exercise and physical activity into your daily routine
- Stretch to stimulate the circulatory system, but also to alleviate abdominal pain
- Supplement your fiber intake with prunes or over-the-counter fiber supplements like Metamucil (if okayed by your doctor)
- Take supplements like magnesium or probiotics to soothe constipation symptoms
Finally, as Health Guides explains, give yourself an appropriate amount of time in the restroom:
“Experts recommend you give yourself plenty of time (and privacy) for toileting if you’re experiencing constipation. Schedule regular times each day where you can sit on the toilet, but if the urge to go strikes at another time, go ahead and go! Waiting to defecate can make a stool get harder and drier, which will make it harder to pass later.”
Eat plenty of natural laxatives
Diet requires a bit more consideration since it has such a huge effect on opioid constipation relief. Arthritis Health recommends incorporating more of the following natural laxatives into your diet. These foods help keep the digestive system working more efficiently and can help alleviate constipation.
- Prunes and prune juice
- Apple cider
- Bran cereals
- Whole grains
- Black beans
- Chick peas
- Healthy oils, like olive or flaxseed oil
Track your symptoms
One way to make it easier to talk to your doctor about your opioid induced constipation is by knowing your exact symptoms when walking into her or his office. If you have a symptom diary in hand, you can have them review it to make suggestions.
The American Chronic Pain Association has created a digital and printable log to keep track of your medication usage, constipation symptoms, and lifestyle habits. You can find that OIC Log here, with links to their iOs and Android stores.
Other mobile apps for tracking opioid induced constipation symptoms include PoopLog, Tummy Trends, and Bowel Movement Pro. These apps aren’t created with constipation in mind. Bowel Movement Pro, for example, is created for those who suffer from IBD. However, many of the tracking functionality can be used for opioid constipation relief.
Check your medications
Finally, opioids can lead to constipation, but other medications can as well. Talk to your doctor about all of your medications that you’re currently on. They may be able to suggest changes that can reduce your risk of constipation.
Your doctor can also discuss methods for reducing your opioid usage to begin with. Many comprehensive and interventional pain specialists focus on treatments that help patients reduce the amount of opioids they use. Reducing use can help you improve your symptoms and reduce your risk factors associated with opioids.
Do note that you should never stop taking a medication unless your doctor has specifically told you to do so.
What opioid induced constipation treatment should I use?
Unfortunately, opioid induced constipation is more difficult to treat than other forms of constipation. Because of this, home remedies and other lifestyle changes may not provide relief. In this case, your doctor may advise you to try the following.
Over-the counter stool softeners and laxatives
Many patients are prescribed daily stool softeners with stimulant laxatives as needed for opioid constipation relief. The Naturopathic Doctor News & Review explains:
“Examples of stimulant laxatives are aloe, cascara, and senna, including brand name over-the-counter senna and bisacodyl products. Several sources recommend starting a combination of a stimulant laxative with a stool softener (such as docusate sodium). Stimulant laxatives act to increase gut peristalsis and motility, which is suppressed by the action of the opiates, while the stool softener holds water in the intestinal lumen to soften dry hard stool.”
The best laxative for opioid induced constipation will depend on your exact symptoms, however most doctors will recommend stimulant laxatives as a first line defense. These are affordable, easy to obtain, and often effective for short-term cases of constipation.
However, as Medical News Today explains, there are multiple types of other-the-counter remedies. There are laxatives that ease defecation and there are also cathartics that accelerate it. These options include:
- Osmotic laxatives that increase water in the gut
- Emollient or lubricating cathartics
- Bulk cathartics that increase bulk and soften stools
When taking any type of laxative, always work closely with your doctor to regulate how much you use and how often. While they can provide relief in some cases, they can also be habit-forming and affect your bowel movements in the future. You should also always use them in addition to other diet and lifestyle modifications.
Opioid induced constipation drugs
For those who don’t respond to over-the-counter options, there are drugs specifically created for more severe cases of opioid induced constipation. The most effective of these are methylnaltrexone and oral naloxone.
Relistor (common name of methylnaltrexone) is indicated for the treatment of opioid induced constipation. It is one of the most effective treatment methods for opioid constipation. A study from The New England Journal of Medicine found that:
“In healthy volunteers, methylnaltrexone reversed the morphine-induced delay in both gastric emptying and oral–cecal transit time without affecting analgesia. A small, randomized, placebo-controlled trial involving long-term methadone users also showed that methylnaltrexone induced laxation (defecation).”
This medication does not increase pain or trigger opioid withdrawal. It also has few other side effects. It is given as an at-home injection in most cases, however, which may be difficult for some patients to administer.
Oral naloxone can also be an option for patients who are under oral oxycodone therapy. You may have heard of this by its brand-name formula known as Movantik. As the European Journal of Pain noted in their trial on this constipation medication:
“Co-administration of PR oral naloxone and PR oral oxycodone is associated with a significant improvement in bowel function compared with PR oral oxycodone alone, with no reduction in the analgesic efficacy of oxycodone.”
Methods for severe cases
If you’re suffering from a severe case of opioid induced constipation, it’s critical that you talk to your doctor. They can provide treatment methods to reduce discomfort and also help you restore normal bowel activity.
If these interventions are ineffective, there are some other treatments your doctor can try in more serious cases. These may include:
- Rectal, or colonic, irrigation
- Manual evacuation
While these methods may be uncomfortable, they are undoubtedly safer than suffering with constipation.
Find opioid constipation relief
If you use opioid medications to manage your pain, it is essential that you work diligently to reduce and prevent cases of opioid induced constipation. The first step is to talk to your doctor. They’ll help you avoid constipation symptoms, suggest treatment methods, and will also work with you to find other complementary treatments to reduce your opioid dosage. Unfortunately, with how opioids work they almost always carry the side effect of constipation. Managing and preventing this from occurring is possible.
To find a pain specialist in your area who has experience with comprehensive pain management beyond medication, click the button below. There you’ll find a map to find a pain doctor near you who can help with your pain and get you back to your life.