Opioid-Induced Constipation

Gorman Medical and other healthcare providers sometimes prescribe opioids to treat pain caused by any number of conditions. While opioids provide relief from pain, they also cause a number of side effects which can affect a person’s quality of life. One such side effect is opioid-induced constipation (OIC).

How do opioids cause constipation?

Opioids bind to specific proteins in the body called opioid receptors. The brain, spinal cord, and gastrointestinal tract all contain these receptors. 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 oversees how the body responds to pain. It also controls involuntary movements, including those of the digestive tract. Thus, taking opioids can result in constipation.

Medications that cause OIC

Medications that cause OIC contain substances such as morphine, codeine, oxycodone, and methadone.

Common prescription medications that cause OIC are:

  • buprenorphine (Belbuca, Probuphine, Buprenex)
  • codeine (APAP wCodeine, Capital wCodeine, Pyrigesic-C, Tylenol wCodeine, Vopac)
  • fentanyl (Actiq, Duragesic, Sublimaze)
  • hydrocodone (Anexsia, Ceta Plus, Co-Gesic, Dolorex Forte, Hycet, Lorcet, Lortab, Maxidone, Norco, Stagesic, Vicodin HP, Zydone)
  • hydromorphone (Dilaudid, Dilaudid-5, Exalgo, Palladone)
  • meperidine (Demerol, Pethidine)
  • methadone (Dolophine, Methadone HCl Intensol, Methadose)
  • morphine (AVINza, Kadian, Morphabond, MS Contin, Oramorph SR, Roxanol)
  • oxycodone (OxyContin, Xtampza ER, Roxicodone, OxyIR, Percocet, Endocet, Percodan, Endodan)
  • oxymorphone (Opana)
  • tapentadol (Nucynta)
  • tramadol (ConZip, FusePaq Synapryn, Rybix ODT, Ryzolt, Ultram)

Symptoms of OIC

Common gastrointestinal symptoms of OIC:

  • difficulty defecating, which can result in straining, forcing, and pain
  • dry, hard stools
  • abdominal tenderness
  • bloating, distention, or bulging in the abdomen
  • constant feeling of needing to use the bathroom
  • alternating episodes of constipation and diarrhea
  • nausea and vomiting
  • tiredness and lethargy
  • weight loss

Treatment of OIC

OIC treatments include lifestyle changes, natural remedies and over-the-counter or prescription medications. Your provider may prescribe preventative medication when they prescribe an opioid to you.

Lifestyle Changes

  • drinking more fluid
  • consuming more fiber 
  • getting some or more exercise, if possible

Natural Remedies

In addition to drinking more water, eating more fiber, and getting exercise where possible, some natural ingredients may also help relieve OIC. These include:

  • fiber supplements such as Metamucil, FiberCon or Citrucel
  • products containing sennosides (such as Senna)
  • aloe vera

Consult with your provider or pharmacist before taking herbal remedies, as they may interact with or decrease the effectiveness of certain medications.  

Over-the-counter Medications

Bulk-forming laxatives: These indigestible fiber supplements move through the body and absorb liquid in the digestive system to form a stool that is easier to pass. Examples include Metamucil, FiberCon or Citrucel.

Osmotic laxatives: Osmotic laxatives work by helping the colon hold more water, which can soften the stool — making it easier to pass — and increase the frequency of bowel movements. One example is magnesium hydroxide (milk of magnesia). 

Saline laxatives: These encourage bowel movements by drawing water into the intestines. Magnesium citrate supplements are one example.

Stool softeners: These increase the amount of water stools absorb, making them softer and easier to pass. Examples include docusate sodium (Colace) and docusate calcium (DulcoEase, Phillips Liqui Gels).  

Lubricant laxatives: These coat the intestine walls and the stool to soften and lubricate the stool. One type is mineral oil.

Stimulant cathartics: These medications (Correctol, Dulcolax, Senna) promote movement in the intestines.

The American Gastroenterological Association Institute recommends traditional laxatives as a first-line treatment for OIC. The organization provides guidelines for medical management of OIC when over-the-counter laxatives do not provide relief.

Prescription Medications

If OIC does not respond to treatment and you as a patient need to stay on opioids for pain control, then there are a host of newer drugs which combat OIC. These drugs work by blocking opioid receptors in the GI tract – allowing normal transit of stool within the bowel. These newer drugs (such as Relistor) do not block pain receptors in the brain, spinal cord or peripheral nerves. The drugs are considerably expensive; and therefore, a last resort for pain management patients.

Laxative Side Effects

Although healthcare professionals generally consider laxatives safe and effective when taken as directed, like all medications, a person may develop side effects from using laxatives to treat OIC. Some common side effects include:

  • diarrhea
  • fluid loss
  • nausea
  • bloating
  • vomiting
  • flatulence
  • abdominal cramping

Talk to your Gorman Medical provider about your symptoms. We are here to support you.