What Is An Opioid-Induced Constipation And How To Treat It?

NOTE: Constipation is defined as having lesser than three bowel movements per week ⁽¹⁾. About 41 to 81% of individuals who take opioids for non-cancer and chronic pain suffer from constipation ⁽²⁾. 

What are Opioids?

Opioids are prescription medications for pain and these can cause a specific form of constipation, which is referred to as opioid-induced constipation (OIC) ^{(3, 4)}. Some of the pain medications that come under the class of opioid drugs are: hydrocodone (Zohydro ER); oxycodone (OxyContin); morphine and codeine.

These are effective medications for pain relief as they act by blocking the pain signals by sticking themselves to the receptors present in the nervous system. The bowels also have these receptors.  When these opioids pain medications attach to the gut receptors, it increases the duration of the passing of the stool through the gastrointestinal system.

To find relief from opioid-induced constipation, there are various medications and natural home remedies which can help.

Medications for Opioid-Induced Constipation consist of:

Over-The-Counter (OTC) Medicines:

Stool Softeners such as docusate calcium (Surfak) and docusate (Colace) work by increasing the quantity of water in the colon, which makes passing of the stools easy.

Stimulants, such as senna-sennosides (Senokot) and biscacodyl (Ducodyl, Dulcolax) increase the intestinal contractions and stimulate the bowel activity thus giving relief to opioid-induced constipation.

A suppository or enema can be inserted into the rectum which helps in softening the stools and stimulating the bowel movements. However, there is a risk of rectal damage if it is not properly inserted.

Osmotics help the fluid move via the colon and these consist of oral magnesium hydroxide and polyethylene glycol ⁽⁵⁾.

A lubricant laxative which is mineral oil also helps in moving the stool through the colon and is available as an OTC option in rectal and oral form ⁽⁶⁾.

Treating Opioid-Induced Constipation with Prescription Medications

Prescription medication, which is specifically for OIC helps in treating the problem at its root. These medications work by stopping the effects of opioids in the gut thus allowing the stools to move easily. Some of the prescriptions approved for the treatment of opioid-induced constipation are: methylnaltrexone (Relistor); naloxegol (Movantik); naldemedine (Symproic) and lubiprostone (Amitiza).

Note: The prescription medications for opioid-induced constipation can have side effects like: headache, nausea, vomiting, flatulence and diarrhea.

Treatment of Opioid-Induced Constipation with Natural Remedies

There are some herbs and supplements that can help relieve opioid-induced constipation by stimulating the bowel activity and these are:

Fiber Supplements:  Fiber has a laxative effect as it increases absorption of water in the colon and this leads to formation of bulkier stools and allows for them to pass easily ⁽⁷⁾. Some of the fiber supplements that can be taken for opioid-induced constipation are methylcellulose and psyllium.

Even though fiber supplements are effective in relieving constipation, there is a need for more research to confirm their effectiveness in opioid-induced constipation.  Along with these supplements, it is also important to drink lot of water as lack of fluids causes dehydration, which worsens opioid-induced constipation and can result in fecal impaction.

Note: Taking fiber supplements can reduce the absorption of certain medications like aspirin. Always consult your doctor before starting on fiber supplement along with any prescription medication. 

Senna is a flowering plant whose leaves have a laxative effect and can be of benefit in opioid-induced constipation. A study done in 2014 showed that senna helped with post-surgery opioid-induced constipation when it was taken daily for about six days ⁽⁸⁾. Senna supplements are available in the form of: tablets, capsules and tea.

Note: It is recommended to take Senna for a short-term basis, as its long-term use can cause diarrhea which can then cause electrolyte imbalance. This herb also carries the risk of bleeding when it is taken along with a blood thinner, such as warfarin.

Aloe vera is also beneficial in relieving opioid-induced constipation. A study showed that rats that were given oral loperamide to induce constipation and which were then given aloe vera in for seven days showed that there was an improvement in intestinal motility and fecal volume in these rats ⁽⁹⁾. So, based off this study, the laxative effect of aloe vera can help with drug-induced constipation in humans too.

Note: Always consult your doctor before taking aloe vera, as it can decrease the effectiveness of some medications like: anti-inflammatories; cholesterol-lowering drugs and hormonal drugs.

Find Relief from Opioid-Induced Constipation with these Lifestyle Modifications and Home Remedies

There are quite a few home remedies that are helpful in improving opioid-induced constipation and in managing its discomfort. Some of them are:

Drink lots of fluids, as dehydration worsens the constipation making it all the more difficult for the stool to pass. Along with drinking 8 to 10 glasses of water in a day, one can also consume other fluids, such as juices, tea and decaf coffee.

Increase physical activity by indulging in regular exercise, as physical activity helps in stimulating intestinal tract contractions and encourages bowel activity.

Consume more fiber, as this will naturally increase the bowel activity. Add more vegetables, fruits and whole grains in your diet. Some of the fiber rich foods consist of: raisins, prunes, asparagus, apricots and beans.

Using heat or ice therapy helps in managing the bloating and abdominal pain, which is a part and parcel of opioid-induced constipation.

Stop eating trigger foods, such as processed and fatty foods that are difficult to digest and can aggravate opioid-induced constipation.

Conclusion

Opioids are great for reducing pain that hasn’t responded to other pain medicines; however, it also carries the risk of constipation.  One can always try home remedies, lifestyle changes and OTC medications for relief. If opioid-induced constipation persists, then consult your doctor for prescription medication to treat it.

References:

Also Read:

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• 35 Simple Home Remedies for Frequent Constipation & Tips to Avoid Constipation
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• How Much Fiber Should I Eat a Day to Treat IBS Constipation?
• Link Between Constipation and Acid Reflux