How To Manage Opioid-Induced Constipation

When you take an opioid, such as hydrocodone (Vicodin, Norco) or oxycodone (OxyContin, Percocet), the drug targets opioid receptors throughout the body. Opioid-induced constipation happens (OIC) when opioids bind to peripheral µ-opioid receptors in the gastrointestinal tract.

Opioids reduce fluid in the intestines and tighten anal muscles, making the stool hard and bowel movement difficult. Constipation is defined as fewer than three bowel movements per week. 

Opioid-induced constipation is one of the most common and troublesome side effects of opioid use. 

Cancer patients on opioid therapy or people who take prescription opioids for chronic noncancer pain are most at risk, as they take the drugs for a prolonged period. People who abuse opioids are also likely to experience adverse effects.

There are several options for the management of opioid-induced constipation. Natural remedies, over-the-counter medications, and prescription drugs may offer some relief.

Natural Remedies For Opioid-Induced Constipation

Lifestyle changes may help with opioid-induced constipation. How much you move, eat, and drink can have a significant impact on your digestive system.

Increase Physical Activity

Physical activity improves digestion, blood flow, and bowel function. More exercise can lead to more frequent bowel movements.

Drink More Fluids

Drinking more fluids prevents stool from being hard and dry, making it easier to pass. However, too much water can cause diarrhea, so be mindful of how fluids affect your body.

Eat More Fiber

Dietary fiber makes the stool solid but soft to avoid constipation. Fruits, vegetables, and grains are fiber-rich foods. Some good choices are raspberries, peas, and whole-wheat spaghetti.

Fiber causes the intestines to absorb more fluid, so be sure to balance your fiber and water intake, or you could end up making constipation worse.

Seek Privacy

If you have a private and comfortable place to go to the bathroom, it can make a big difference. A successful bowel movement depends on relaxation.

Get Into Position

The BMJ (formerly the British Medical Journal) recommends positioning yourself on the toilet to relax the muscles essential for defecation. Sit with “knees higher than hips, leaning forward with elbows on knees, straightened spine.”

Try A Natural Supplement

Fiber supplements, such as Metamucil and Citrucel, can help you add fiber to your diet if you have trouble getting enough through food. Senna is an herb with laxative effects that’s available over-the-counter. You can get it in capsules or as a tea.

Treating Opioid-Induced Constipation With Over-The-Counter Medications

If lifestyle changes don’t help with opioid-induced constipation, you may want to try over-the-counter medication. There are several medications for OIC that don’t require a prescription.

Oral Laxatives

Oral laxatives are medications taken by mouth that help you have a bowel movement. There are three types of oral laxatives:

• Stool softeners, like docusate (Colace), give stool a softer consistency that is easier for the bowels to excrete.
• Stimulant laxatives increase intestinal activity to stimulate bowel movement. Bisacodyl (Dulcolax) and Senna are stimulant laxatives.
• Osmotic laxatives, such as polyethylene glycol (Miralax), draw water into the intestines to lubricate and soften stool. 

Rectal Laxatives

Stimulant laxatives, like bisacodyl suppository, are inserted into the rectum rather than taken orally. They take effect much quicker with this method, producing a bowel movement in a few minutes rather than a few hours.

Other rectal options include glycerin suppositories and enemas. A glycerin suppository is a lubricant that’s put into the rectum to help stool come out smoothly. An enema is an injection of fluid into the bowel system through the rectum.

Prescription Drugs For Opioid-Induced Constipation

Several prescription drugs are available for the direct treatment of opioid-induced constipation. 

Some are peripherally acting µ-opioid receptor antagonists (PAMORAs), which means they bind to opioid receptors in the gastrointestinal tract and block the effects of opioids. If you take these medications, your opioid prescription will still be effective, but it won’t cause constipation.

Prescription opioid receptor antagonists include:

• methylnaltrexone (Relistor)
• naloxegol (Movantik)
• naldemedine (Symproic)

Lubiprostone (Amitiza) can treat opioid-induced constipation, as well as chronic idiopathic constipation (more than three months of constipation, not caused by disease or medication). It increases fluid in the bowel to ease the passing of stool.

These prescription medications can cause adverse effects, including diarrhea, abdominal pain, and gas. Speak with your doctor about your condition to decide whether the side effects are worth it.

Another prescription medication that can help with opioid-induced constipation is prolonged-release oxycodone/naloxone. 

As an opioid, oxycodone PR has an analgesic effect that makes it effective for pain management. It’s much less likely to cause bowel dysfunction when paired with naloxone PR.

How To Manage Opioid-Induced Constipation

If you have an advanced illness or chronic pain that requires opioid therapy, opioid-induced constipation may be something you have to deal with. Some methods work better than others. What works best for you depends on your personal needs.

Your primary healthcare provider or a clinician who specializes in gastroenterology (digestive system function) may be able to guide you in the right direction.

If you’re suffering from opioid-induced constipation as a side effect of opioid abuse, these methods can help with symptoms but won’t cure the underlying problem. Seeking help for opioid addiction may be a vital step to improving your quality of life.

To learn more about managing opioid-induced constipation, reach out to an Ark Behavioral Health specialist today.