What to Know About Laxatives and Opioid-Induced Constipation

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Nancy LeBrun

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PHYSICIAN CONTRIBUTOR

Treatment Options for Painkiller-Induced Constipation

Farshad Ahadian, MD, recommends a variety of treatments for opioid-induced constipation.
laxative-pills

If you have chronic pain, your doctor may have prescribed opioids—narcotics—to give you relief. These medicines are a valuable tool for controlling discomfort, but like many drugs, they can have side effects. Constipation is one of the most common, because the same mechanism that helps control your pain also affects your digestive system.


When taking opioids, you may experience infrequent bowel movements, straining, hard stools and bloating. This condition, called opioid-induced constipation, or OIC, doesn’t usually go away on its own. Staying hydrated, keeping active and eating a high fiber diet can help, but you may need laxatives to help you have more frequent bowel movements. In fact, your doctor may start you on laxatives even before you begin taking opioids, as this has been shown to alleviate OIC later on.

Opioids may bring effective pain relief, but they also come with some baggage. Unfortunately, because of how they work in the body, opioids tend to cause uncomfortable, embarrassing, and painful constipation. Experts discuss why this occurs and what patients can do to find relief.

Medical Reviewer: William C. Lloyd III, MD, FACS Last Review Date: Jul 18, 2016

2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

Over-the-Counter Laxatives

Over-the-counter products include bulk laxatives like Benefiber, Citrucel and Metamucil, which contain ingredients like psyllium husk and bran. However, doctors often advise that people with OIC avoid bulk laxatives, as they can make your opioid-related constipation worse and have the potential to cause bowel blockages. Stimulant laxatives like Dulcolax and Senekot work by directly triggering intestinal contractions, but they can be harder on your system, causing cramping, diarrhea and nausea. Your doctor may suggest using a stool softener or fiber supplement in addition to a laxative. You can also talk to your doctor about glycerin suppositories or enemas.

However, no matter what product or combination you try, over-the-counter laxatives may not do the trick, because opioid constipation is different from other kinds. In fact, about half the people who have opioid-induced constipation don’t get relief from them. If you’re still constipated, you may need a prescription medication.

Prescription Medication

In the last few years, prescription medicine options for OIC have come a long way. Treatment will depend on the dose and type of pain medicine you are taking, as well as other health-related conditions. But, medications that your doctor can prescribe for you are formulated specifically to overcome the way opioids affect your system and help you have more comfortable bowel movements. Among the options available through your healthcare provider are:

  • Naloxegol (Movantik), a pill which works by protecting your intestines from the effects of the opioids

  • Methylnaltrexone bromide (Relixor) which works in the same way as naloxegol, but is injected rather than taken by mouth

  • Lubiprostone (Amitiza), a pill that increases fluid in the intestines and makes it easier to pass stools.

These drugs should not affect how well your pain medication works, but talk to your doctor about other possible side effects. Though it may feel awkward discussing constipation, it’s important to tell your healthcare provider how often you have bowel movements, your level of activity, your diet and how much liquid you drink. Opioid-induced constipation is very common and can be extremely uncomfortable, up to the point where you may not want to take your pain medication. The more information you offer, the better the chances are that your doctor can help you address OIC and not let it affect your quality of life.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jan 28, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Management of Opioid Induced Constipation. UW (University of Wisconsin) Health. http://prc.coh.org/pdf/OpioidIndConst9-11.pdf
  2. Constipation. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/constipation/in-depth/laxatives/art-20045906?pg=2
  3. Pain Relief, Opioids, and Constipation. Harvard Health Publications. http://www.health.harvard.edu/pain/pain-relief-opioids-and-constipation
  4. Management of Common Opioid Induced Adverse Effects. American Academy of Family Physicians. http://www.aafp.org/afp/2006/1015/p1347.html
  5. Opioid Induced Bowel Dysfunction. International Journal of Clinical Practice. U.S. National Library of Medicine. National Institutes of Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1974804/
  6. Lubiprostone, Medline Plus, U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a607034.html
  7. Naloxegol, Medline Plus, U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a615016.html
  8. Methylnaltrexone Injection. Medline Plus, U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a608052.html
  9. High-fiber foods. Mayo Clinic. http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948

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