What is opioid-induced constipation?
People use opioids to manage severe pain. Opioid-induced constipation (OIC) can cause further discomfort, which can affect a person's quality of life.
However, treatment is often available through natural means or in the form of over-the-counter or prescription medication.
Read on to learn more about the link between opioids and constipation.
How do opioids cause constipation?
Opioids are a medication that are useful for treating severe pain, especially during the later stages of cancer.
They contain substances such as morphine, codeine, oxycodone, and methadone.
Opioids offer effective pain relief, but they can also cause constipation.
Some brand names of these drugs include:
Opioids bind to specific proteins in the body called opioid receptors. These are present in the brain, spinal cord, and gastrointestinal tract.
By binding to these receptors, opioids block the brain's ability to perceive pain.
However, opioids also depress, or slow down, the central nervous system.
The central nervous system is responsible for the pain response, but it also controls the body's movements, including the involuntary movements that make digestion possible.
For this reason, opioid use can result in constipation.
Common physical symptoms of opioid-induced constipation (OIC) include:
- dry, hard stools
- difficulty defecating, which can result in straining, forcing, and pain
- a constant feeling of needing to use the bathroom
- bloating, distention, or bulging in the abdomen
- abdominal tenderness
- nausea and vomiting
- tiredness and lethargy
- appetite loss
There are many ways to ease constipation that results from opioid use.
Some natural ways to alleviate constipation include:
- drinking more fluid
- consuming more fiber
- getting some or more exercise, if possible
- taking time to use the bathroom without feeling hurried
A doctor may offer laxatives or other treatment to prevent constipation when they prescribe the opioids.
Over-the-counter and prescription medications can also help.
As constipation is a common side effect of opioid use, a doctor may prescribe medication to prevent it when they prescribe the opioid. This can prevent the problem from developing.
- osmotic laxatives, which soften the stool by increasing the amount of water in the intestines
- emollients or lubricants, which soften and lubricate the stool
- stimulant cathartics, which promote movement in the intestines
- prostaglandins or prokinetic drugs, which increase the bulk and movement of the stool by changing how the intestines absorb water and electrolytes
- medications that block the effects of opioids on the bowel and help ease constipation
Some natural ingredients may also relieve opioid-induced constipation.
Senna, for example, is available in teas, remedies, and pharmaceutical preparations. However, doctors usually only recommend taking senna for occasional constipation.
Also, aloe vera is a traditional ingredient in constipation remedies. However, these are no longer sold over the counter in the United States, because their safety and effectiveness are uncertain.
Speak to a doctor before taking an herbal remedy, because some remedies can interfere with medications.
Who uses opioids?
Doctors prescribe opioids to treat chronic pain.
They also frequently prescribe opioids as a palliative element of cancer treatment.
Palliative cancer care
Doctors often prescribe opioid medications for people with cancer, especially when the disease is in later stages.
In 2017, researchers published the results of an investigation into how types and dosages of opioid prescriptions changed over a 6-year period for people with cancer.
The researchers studied 750 relevant U.S. health records for 2010–2015. Their findings suggest that pain affects:
- about 39 percent of people who have survived cancer
- around 55 percent of people who are currently receiving treatment for cancer
- about 66 percent of people with cancer that is in an advanced, metastatic, or terminal stage
Conditions that cause chronic pain
Doctors may also prescribe opioids to treat:
According to research from 2008, almost 90 percent of people with moderate or severe chronic pain use opioids as treatment.
Results of various studies suggest that opioid-induced constipation affects 41–81 percent of people with chronic pain that does not result from cancer.
Other side effects of opioids
Opioids can have other serious adverse effects, including:
- slower breathing and general depression of the respiratory system
There is also a risk of dependence, overdose, and misuse.
As a result, the U.S. Centers for Disease Control and Prevention (CDC) have expressed concern about overprescription of these types of drugs.
Anyone who is using opioid medication for pain relief should be aware that constipation is a common side effect.
Drinking plenty of water, eating high-fiber foods, and keeping active, where possible, can help reduce the impact.
If these are not enough, a doctor will be able to recommend some treatment options.