Opioid induced constipation

Opioid-Induced Constipation

Table of Contents

What is Opioid-Induced Constipation?

One of the reasons that opioid medications work so effectively is because they block pain receptors in nerves throughout the body. The gut is full of pain receptors, so opioids work to block them. However, when opioids attach to these receptors in the bowels, it slows down the motility in the gut. This slow movement results in a longer amount of time for food to pass through the gut. In addition to fewer bowel movements, it can also cause hard stools that are difficult to pass.   

Medical professionals define opioid-induced constipation as having less than three bowel movements in a week due to opioid use.

How Common is Opioid-Induced Constipation?

Constipation is a common side effect of taking opioids and a natural reaction to the substance being in the body. Experts estimate that anywhere from 41-81% of those who take opioids for chronic, non-cancer pain, will experience opioid-induced constipation. 1

Constipation from Legal Prescriptions

Opioids are a common type of pain medication. Some common legal opioids include:

These medications are all legal with a prescription from a doctor. However, they still do carry a risk of abuse and misuse. Legal opioids can also cause constipation as a side effect. If you are experiencing opioid-induced constipation resulting from one of these medications, be sure to speak with your doctor about alternatives.  

Constipation from Illegal Opioids

In addition to prescription medication, other forms of illegal opioids can cause constipation in the body, sometimes called heroin constipation. Some of these opioids include: 

  • Heroin
  • Fentanyl
  • Carfentanil
  • Opium

Unlike legal opioids, there is no medical justification for these drugs, and they are not prescribed by doctors. As a result, they are typically acquired on the street, and individuals are less likely to seek help for heroin constipation. However, some options can help relieve discomfort.  

How is Opioid-Induced Constipation Treated?

There are a number of treatment options when constipation occurs from opioid use. Some common forms of treatments include:

Naloxone

Health professionals typically prescribe Naloxone to quickly reverse the effects of too many opioids in the body. Naloxone works by attaching to the receptors in the body to counteract an opioid overdose. Although it is often used to restore breathing in cases where an overdose has caused breathing to slow or stop, this treatment can also offset some of the side effects of opioids like constipation. Researchers have found that even low doses of Naloxone can reverse opioid-induced constipation.2 Because it blocks the ability of opioids to attach to receptors in the bowel, it can help the gut function normally. Naloxone will not treat an opioid use disorder and will not have an effect if there are no opioids present in the body. It is typically taken either by injection or as a nasal spray, and it does not need to be administered by a health professional. However, even low doses can reverse the pain-relieving effects of opioids, making it a poor option for those who use opioids to manage their pain.

Laxatives

There are three types of over the counter (or OTC) medications used to treat opioid-induced constipation. These different forms of laxatives work to induce bowel movements:

  • Stimulants such as senna-sennosides (in medication such as Senokot) and Bisacodyl (which is used in Dulcolax and Ducodyl) induce intestinal contractions to move food along in the gut.
  • Osmotics, such as Milk of Magnesia and MiraLax, encourage fluid to move through the intestinal tract. They usually use either oral magnesium hydroxide or polyethylene glycol.
  • Stool softeners are also a common way to encourage bowels. They enable stool to pass more easily by increasing the water in the colon. It usually either includes docusate calcium (like in Surfak) or docusate (in Colace).  

Natural Remedies

For those who want or need a more natural solution, certain herbs, activities, and remedies can help increase bowel activity:
  • Fiber supplements can increase water in the bowels to encourage gut motility. Individuals should strive to have between 25-30 grams of fiber each day for their gut health. It is important to drink enough fluids while taking a fiber supplement to avoid dehydration or fecal impaction. Be sure to check with a doctor before taking fiber with any prescription medication.
  • Increasing movement can also encourage regular bowel movements. About 30 minutes of exercise can help stimulate contracts in the intestinal tract.
  • Aloe vera can also provide help for constipation. Researchers have found that aloe vera can help induce bowel activity in instances of drug-induced constipation. 3 However, it can also decrease the effectiveness of some medications, so it is important to check with a health professional first before supplementing.

The Problems with Laxatives for Opioid-Induced Constipation

For those who need short-term relief, Naloxone and laxatives can be an option. Short-term use of opioids, such as healing after surgery, might necessitate the use of temporary support. However, it is important to keep in mind that laxatives are not a long-term solution. Some of the issues relying on laxatives can cause include: 

Not Treating the Underlying Cause

In the case of an opioid use disorder, the short-term relief that laxatives might bring does not address the long-term issues and underlying cause that led to the discomfort. Recent research shows that long-term opioid use is linked to significant microbiome and gut health disruption. 4 This disruption means that if exposed to opioids for too long, the body can respond with compromised health. If the constipation is caused by an opioid use disorder, then medication can only mask uncomfortable symptoms, not prevent the long-term effects of opioid use.

Minimal Effectiveness

When the body is exposed to a medication for an extended amount of time, it grows accustomed to it. In the case of laxatives, this means that it eventually stops having the same effect. It is common with long-term laxative use to develop a dependency. The body might subsequently not be able to have a bowel movement without the presence of laxatives.   

Opioid Antagonists for Opioid-Induced Constipation

Another possible treatment for constipation is the use of other opioid antagonists in addition to Naloxone. Researchers have spent the last couple of decades studying the effectiveness of antagonists for treating opioid-induced constipation. A 2018 meta-analysis of over 27 placebo-controlled trials found that opioid antagonists are a safe and effective treatment for opioid-induced constipation. 5 The medication can be an effective treatment for recovery and to help keep the gut regular and healthy.