Laxatives And Opioids: Constipation Relief Or Risk?

Opioids are a type of prescription pain medication that can cause constipation, known as opioid-induced constipation (OIC). OIC affects quality of life and can be persistent. It occurs when opioids attach to receptors in the gut, lengthening the time it takes for stool to pass through the gastrointestinal system.

Laxatives are often recommended as the first line of treatment for OIC. They can be bought over the counter and include stimulant laxatives, stool softeners, and enemas. However, it is important to consult a doctor or pharmacist to determine the most suitable option and to prevent potential side effects.

In addition to laxatives, increasing fluid intake, consuming more fiber, and engaging in physical activity can also help relieve OIC.

Laxatives and stool softeners

Laxatives

Laxatives help your bowels move the stools out. You can buy many of these treatments over the counter. Ask your doctor or pharmacist which ones may be best for you and how long you’ll need to take them. They'll start working after a few hours or a couple of days, depending on which laxative you use.

Stool Softeners

Stool softeners make hard, dry waste easier to pass out of your body. You can buy many of these treatments over the counter. Ask your doctor or pharmacist which ones may be best for you and how long you’ll need to take them. They'll start working after a few hours or a couple of days, depending on which stool softener you use.

When to Take Laxatives and Stool Softeners

It is recommended to take laxatives and stool softeners at the same time as the opioid to prevent OIC. Laxatives and stool softeners are ideal for preventing constipation; they do not work well for established cases of constipation.

Drink more water

Drinking more water is one of the most important ways to prevent opioid-induced constipation (OIC). Dehydration is a common cause of constipation, and opioids can make this worse. It can be challenging to get enough fluids when you're in pain, so it's important to make a conscious effort to drink more water throughout the day, even if it's just a little at a time. Aim for 8-10 glasses of fluid per day, and include hot liquids like coffee, tea, or broth, which can also help get things moving. Eating foods with a high water content, such as watermelon or berries, can also help.

Water is essential for digestion and healthy bowel function. When you're taking opioids, it's crucial to stay hydrated to prevent constipation. Opioids can slow down the movement of food through the digestive tract, and dehydration can exacerbate this problem, making it harder for stool to pass. By drinking more water, you can help ensure that things keep moving smoothly through your digestive system and reduce the risk of becoming constipated.

In addition to increasing your water intake, there are several other things you can do to prevent OIC:

• Increase your fibre intake: Fibre helps add bulk to stool and makes it easier to pass. Include more fruits, vegetables, and whole grains in your diet.
• Exercise regularly: Physical activity stimulates contractions in the intestinal tract and promotes bowel movements.
• Avoid trigger foods: Fatty and processed foods can be difficult to digest and may worsen constipation.
• Stick to a routine: Try to go to the bathroom at the same time each day, preferably after a meal.
• Talk to your doctor: If you're taking opioids, let your doctor know so they can provide guidance and recommendations to help prevent constipation.

Eat more fibre

Opioid-induced constipation (OIC) is a common side effect of opioid medication, affecting 41 to 81 percent of people who take opioids for chronic, non-cancer pain. OIC occurs when opioids attach to receptors in the gut, lengthening the time it takes for stool to pass through the gastrointestinal system. This can cause discomfort and impact a person's quality of life.

To prevent and manage OIC, it is important to eat more fibre. Fibre has a laxative effect, increasing water absorption in the colon, which helps to form bulkier stools that pass through the intestines more easily. The current recommended intake of fibre for adults is between 25 to 38 grams per day, but on average, people consume 15 grams or less.

• Consume more fruits, vegetables, and whole grains. Good sources of fibre include apples, bananas, prunes, pears, raspberries, string beans, broccoli, spinach, kale, squash, lentils, peas, and beans.
• Include high-fibre foods such as bran products (usually cereals), nuts, and legumes (e.g., black or pinto beans, chickpeas).
• Eat the edible skins of fruits and vegetables, such as apples and potatoes, as they are often the most fibre-rich part.
• Take fibre supplements such as psyllium (Metamucil) or methylcellulose (Citrucel). Follow the directions on the product and ensure you drink plenty of fluids while taking these supplements.
• Be cautious when combining fibre supplements with certain medications. For example, fibre can decrease the absorption of aspirin. Consult your doctor before taking fibre supplements with prescription medications.
• If you are taking opioids and are nearly or completely immobile, consult your doctor before increasing your fibre intake.

While increasing fibre intake is a recommended strategy to manage OIC, it is important to note that too much fibre can cause abdominal cramping and diarrhoea. Therefore, it is advisable to slowly increase your fibre intake and ensure adequate fluid intake to prevent dehydration, which can worsen constipation.

Get active

Physical activity is an important part of preventing and relieving opioid-induced constipation. Exercise stimulates contractions in the intestinal tract and promotes bowel activity, helping to get your bowels moving.

It is recommended to aim for 30 minutes of exercise on most days of the week. However, it is important to talk to your doctor before starting a new exercise routine, especially if you are taking opioid medications. They can advise on what kind of activity and intensity level might be suitable for you.

Even a little bit of gentle movement can help to get your bowels moving and provide relief from constipation. Some examples of light exercises that may be suitable include:

• Walking
• Light stretching
• Doing chores around the house

Prescription medications

Opioid-induced constipation (OIC) is a common side effect of opioid pain medications, affecting 40-60% of patients without cancer who are prescribed opioids. OIC is caused by opioids attaching to receptors in the gut, which slows down the passage of stool through the gastrointestinal system. This can lead to hard stools and constipation, as well as other gastrointestinal (GI) side effects such as nausea, vomiting, bloating, abdominal pain, and straining.

If you are experiencing OIC, it is important to talk to your doctor about treatment options. Prescription medications specifically for OIC include:

• Naloxegol (Movantik)
• Methylnaltrexone (Relistor)
• Lubiprostone (Amitiza)
• Naldemedine (Symproic)

These medications block the effects of opioids in the gut and help stools pass more easily. They are typically prescribed when over-the-counter (OTC) laxatives and stool softeners, increased fluid intake, and dietary and lifestyle changes are not sufficient to relieve constipation.

Methylnaltrexone, lubiprostone, and naldemedine are peripherally acting μ-opioid receptor antagonists (PAMORAs) that selectively block μ-receptors in the gastrointestinal tract, preventing the side effects of opioids on the gut while preserving pain relief. Naloxegol is the first orally administered PAMORA and is typically prescribed at a dose of 25 mg/day. Methylnaltrexone is available in oral and subcutaneous formulations, with the recommended dose for the subcutaneous formulation being 8 mg/day for patients up to 62 kg and 12 mg/day for patients up to 114 kg. Lubiprostone is a type-2 chloride channel activator that increases fluid secretion in the GI tract, enhancing peristalsis and accelerating colonic transit times. Naldemedine has a similar structure to naltrexone but is less able to cross the blood-brain barrier, and is the most recently approved PAMORA.

These prescription medications may cause side effects such as abdominal pain, diarrhea, nausea, vomiting, and headache. It is important to speak with your doctor if you experience any side effects, as they may recommend modifying your dosage or switching to a different medication.

Frequently asked questions