Opioids, a type of prescription pain medication, can trigger a specific type of constipation known as opioid-induced constipation (OIC).
Opioid drugs include pain medications such as:
- oxycodone (OxyContin)
- hydrocodone (Zohydro ER)
These medications are effective because they block pain signals by attaching to receptors throughout your nervous system. These receptors are also found in your bowels.
When opioids attach to receptors in your gut, it lengthens the amount of time it takes stool to pass through your gastrointestinal system.
Constipation is defined as having fewer than three bowel movements a week. Anywhere from 41 to 81 percent of people who take opioids for chronic, noncancer pain experience constipation. There are medications and natural and home remedies that can help you find relief.
- Stool softener: These include docusate (Colace) and docusate calcium (Surfak). They increase the amount of water in your colon and help stools pass easier.
- Stimulants: These include biscacodyl (Ducodyl, Dulcolax) and senna-sennosides (Senokot). These induce bowel activity by increasing intestinal contractions.
- Osmotics: Osmotics help fluid move through the colon. These include oral magnesium hydroxide (Phillips Milk of Magnesia) and polyethylene glycol (MiraLAX).
Mineral oil is a lubricant laxative that also helps stool move through the colon. It’s available as an OTC option in oral and rectal form.
An enema or suppository inserted into the rectum may soften stools and stimulate bowel activity. There’s a risk of damaging the rectum if it’s inserted improperly.
Prescription medication specifically for OIC should treat the problem at its root. These medications block the effects of opioids in the gut and help stools pass more easily. Prescriptions approved for the treatment of OIC include:
- naloxegol (Movantik)
- methylnaltrexone (Relistor)
- lubiprostone (Amitiza)
- naldemedine (Symproic)
These prescription medications may cause side effects, such as:
- flatulence (gas)
Speak with your doctor if you experience side effects. It may help to modify your dosage or switch to a different medication.
Some supplements and herbs can relieve OIC by stimulating bowel activity. These include:
Fiber has a laxative effect because it increases water absorption in the colon. This forms bulkier stools and helps stools pass easier. Bulk-forming fiber supplements include psyllium (Metamucil) and methylcellulose (Citrucel).
Although fiber supplements are an effective remedy for constipation, more studies and research are needed to confirm the efficacy of fiber supplements for OIC.
Fiber can be a treatment for this specific type of constipation, but it’s important to drink plenty of fluids while taking a fiber supplement. If you don’t drink enough fluids, dehydration can make OIC worse and cause fecal impaction.
You should eat between 25 to 30 grams of fiber per day. Take one to three tablespoons daily of Citrucel or use Metamucil up to three times a day. Be sure to follow the directions on the Citrucel or Metamucil product you use.
Fiber supplements can decrease the absorption of some medications such as aspirin. Talk with your doctor before combining a fiber supplement with any prescription medications.
Aloe vera may also relieve OIC. In one study, rats were given an oral administration of loperamide to induce constipation. They were then treated with aloe vera in the following doses for seven days: 50, 100, and 200 milligram (mg) for each kilogram of body weight.
The study found that the rats receiving the extract had improved intestinal motility and fecal volume. Based on the study, the laxative effect of aloe vera may improve drug-induced constipation.
Consult a doctor or pharmacist before taking aloe vera. The herb may decrease the effectiveness of certain medications, such as:
- cholesterol-lowering drugs
- hormonal drugs
Senna is a yellow flowering plant. Its leaves have a laxative effect that can help naturally relieve OIC. A small
Senna supplements are available as:
You can buy dry senna leaves from a health foods store and brew them in hot water. Or, you can purchase sennosides tablets (Senokot) from a grocery or drugstore.
The usual starting dose for adults is 10 mg to 60 mg daily. Children should take a smaller amount of senna, so be sure to read the product’s label for recommended doses.
Senna should be taken on a short-term basis. Long-term use can cause diarrhea and trigger an electrolyte imbalance. This herb may also increase the risk of bleeding when taken with warfarin (Coumadin), a blood thinner.
A few home remedies may also improve OIC or help you manage discomfort. Try these along with medications or natural remedies:
1. Increase physical activity. Exercise and physical activity stimulate contractions in the intestinal tract and promote bowel activity. Aim for 30 minutes of exercise most days of the week. Talk with your doctor before starting a new exercise routine.
2. Drink plenty of fluid. Dehydration makes it difficult to have a bowel movement. Drink 8-10 glasses of fluid per day. Stick to:
- decaf coffee
3. Eat more fiber. Increase fiber intake naturally to normalize bowel activity. Add fruits, vegetables, and whole grains to your diet. Excellent sources of fiber include:
Too much fiber can cause diarrhea and abdominal cramping. Slowly increase your intake.
5. Eliminate trigger foods from your diet. Fatty and processed foods are difficult to digest and may make OIC worse. Limit your intake of trigger foods, such as fast foods and junk foods.
Although opioids can reduce your pain, there’s the risk of constipation while taking these medications. If lifestyle changes, home remedies, and OTC medications don’t provide the desired results, talk to your doctor about prescriptions to help regulate your bowel activity.