Opioid-Induced Constipation

Opioid-induced constipation is a side effect of opioid use, whether as directed or for recreational purposes. Untreated opioid addiction can lead to the worsening of the opioid-induced constipation, which may lead to intestinal blockage and other complications.
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Opioid receptors are located in the brain, spinal cord and digestive tract. The µ-opioid receptors — or MOR receptors — are a subset of opioid receptors that exist in each of these locations. When opioids attach to the MOR receptors in the digestive tract, they slow the activity of the gastrointestinal system.

Opioids can slow or stop the contraction of muscles that move food through the digestive tract. This is called peristalsis, and it can lead to opioid-induced constipation, or OIC.

Symptoms of OIC include hardened stool, a decreased urge to use the bathroom, trouble moving your bowels and the sensation that your bowels have not been emptied. Opioid-induced constipation can lead to abdominal cramping and a protruding stomach.

When OIC is left untreated it will block your intestines, which can be dangerous. Anywhere from 41 to 81 percent of people who take opioids for chronic, non-cancer pain experience OIC.

Additionally, OIC can be a symptom of opioid addiction in people who misuse the medication. It is important to seek medical treatment to alleviate OIC before it worsens.

Treating Opioid-Induced Constipation

There are various pharmaceutical and natural remedies to alleviate OIC. The best remedy depends on the person and how they react to treatment.

Switching Opioids

Changing to a different medication may lessen constipation and other opioid side effects. When changing your dosage doesn’t alleviate your OIC, talk to your doctor about trying a different medication.

Some studies have shown that fentanyl may cause less constipation than morphine. Tapentadol may cause less constipation than oxycodone, and methadone may also be generally less likely than other opioids to cause constipation.

It is important to find the right opioid that has the best balance of pain relief and fewer side effects.

If you’re using opioids for reasons and in doses other than those diagnosed and prescribed by a doctor, you may be dependent on the drugs and in need of opioid addiction treatment. Talk to your doctor about your OIC and any concerns about your misuse of the drugs.

Medications for Opioid-Induced Constipation

There are specific drugs that are made to manage OIC and can be prescribed by a doctor for more severe constipation. These medications work by blocking the effects that opioids have on your gut.

Most of these medications come in the form of a pill, such as lubiprostone (Amitiza). However, you can also receive medicine in the form of a shot, such as methylnaltrexone (Relistor).

Movantik is the brand-name version of naloxegol, which is an opioid antagonist that blocks peripheral opioid receptors without affecting the drug’s capacity to manage pain. Movantik is taken orally, once a day, on an empty stomach at least one hour before a meal or two hours after eating.

If you cannot swallow a pill, you may crush the tablets to a powder and mix it in 4 ounces of water to drink immediately. You cannot take laxatives while taking Movantik.

Opioid antagonists have adverse side effects that may include:

  • Abdominal pain
  • Diarrhea
  • Gas
  • Opiate withdrawal symptoms, such as sweating, chills and anxiety

Always contact your doctor if adverse symptoms worsen, as it may be sign of a larger medical problem.

What Are the Best Laxatives and Stool Softeners for Constipation?

Laxatives and stool softeners are common over-the-counter medicines used to increase the amount of water in your colon and help stool pass more easily. There is a difference between laxatives and stool softeners. Laxatives help you have a bowel movement while stool softeners are a type of laxative called an emollient laxative.

Laxatives are prescribed in 85 percent of doctor visits involving constipation. They are available as pills, capsules, liquids and enemas. Each laxative has specific benefits and adverse side effects. Choosing the correct laxative and using it as directed will prevent in chronic constipation caused by misuse or overuse.

Bulking Agents (Fiber)

Fiber plays an important role in combatting bloating and gas. When you cannot get enough fiber in your diet, over-the-counter fiber supplements, such as Benefiber and Fiber-Lax, can help move stool through your colon. This is the most natural approach to laxatives.

Fiber reduces your body’s absorption of some drugs, so take any medications at least one to two hours before consuming a fiber supplement.

Lubricant Laxatives

Lubricant laxatives make stool slippery with mineral oil. Mineral oil adds a slick layer to the walls of the intestines and stops stool from drying.

Though highly effective, lubricant laxatives are for short-term use only. Over a long period of time, mineral oil can absorb fat-soluble vitamins from the intestines and prevent your body from absorbing prescription drugs. You should not take mineral oil while taking other medications or supplements.

Stool Softeners

Stool softeners (emollient laxatives) contain docusate, a surface that helps wet and soften stool. It may take a week or longer for stool softeners take effect. These commonly come in the form of oral soft-gel capsules, oral liquids or rectal enemas.

What Home Remedies Relieve Constipation?

Supplements and herbs can relieve OIC by stimulating bowel activity. These are natural alternatives to medication for combatting constipation.

Doctors also recommend changing your diet to include healthier options and limiting processed foods. If your opioid-induced constipation is mild, introducing more fiber from fruits and vegetables should keep stool soft and speed digestion.

In addition to fruits and vegetables, make sure to include whole grains and beans in your diet. Plants such as aloe vera and senna are available as dietary supplements in pill and capsule formulas.

Regular exercise will move food more quickly through your digestive system, and bloating from can be treated with ice or heat therapy.

Of course, quitting opioids will effectively reduce or eliminate opioid-induced constipation and other side effects, but if you are dependent on the drugs, this is easier said than done. Most treatment programs for opioid use disorder include detox, inpatient treatment, some form of medication-assisted treatment, and counseling and support groups.

Detoxing from opioids is a difficult process that is best completed in a medical setting. If you think your opioid-induced constipation is the result of addiction, don’t simply address the symptoms. The sooner you begin treatment, the sooner you’ll get your health and your life back on track.

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