What Is Opioid Painkiller-Induced Constipation? Recommendations for Cancer Patients

This article covers treatments for opioid-induced constipation, including natural approaches and medicines.

How Do Opioids Cause Constipation?

Opioids work by binding 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 suppress or slow down the central nervous system.

The central nervous system, which includes the brain, governs how the body responds to pain. It also controls involuntary smooth muscle movements, including those in the digestive system.

For this reason, taking opioids can cause constipation by relaxing these smooth muscles.

Note: Tolerance to the pain-relieving effects and side effects of opioids develops over time; a dose increase may be needed to maintain pain relief, while side effects such as nausea and drowsiness may diminish. Constipation is the exception: constipation is always expected in people taking opioids.

Which Medicines Cause Opioid-Induced Constipation?

Medicines that cause opioid-induced constipation (OIC) contain substances such as morphine, codeine, oxycodone, and methadone.

The medicines most commonly causing OIC are listed below (the active ingredient first, with brand/package names in parentheses):

• buprenorphine (Suboxone, Transtec)
• codeine (Fenokodin)
• fentanyl (Actiq, Duragesic)
• meperidine (Aldolan)
• morphine (Morfia tablet, M-eslon capsule, Morphine ampoule)
• oxycodone (Oxopane)
• tramadol (Contramal, Contratek, Madol, Tradolex, Tramosel, Ultramex)

Common gastrointestinal signs and symptoms of opioid-induced constipation (OIC) include:

• abdominal tenderness
• abdominal bloating and tightness
• frequent urination
• episodes of constipation and diarrhea
• difficulty passing stools, which can cause straining, effort, and pain
• dry, hard stools
• nausea and vomiting
• fatigue and drowsiness
• weight loss

How Is Opioid-Induced Constipation Treated?

Various treatments can help with constipation caused by these narcotic analgesics (painkillers). These include lifestyle changes, natural approaches, and medicines.

Lifestyle Changes

Lifestyle changes may include changes in diet and behavior. Some lifestyle changes help relieve constipation. These include;

• drinking more fluids,
• consuming more fiber (see How much dietary fiber should we consume?),
• exercising, or exercising a little more if already active

Medicines

Over-the-counter and prescription medicines can also help with constipation. According to cancer treatment guidelines, when a patient is prescribed an opioid painkiller, prescribing medicines to prevent constipation alongside it is recommended.

Constipation medicines also available without a prescription include:

• Bulk-forming laxatives: These indigestible fiber supplements move through the body and absorb fluid in the digestive system, forming a stool that passes more easily through the bowel. Examples include methylcellulose, polycarbophil (FiberCon), and psyllium (Metamucil, Konsyl).
• Osmotic laxatives: Osmotic laxatives work by helping the colon retain more water, which can soften stools - making them easier to pass - and increase the frequency of bowel movements. One example is magnesium hydroxide (Magnesie Calcinee Saba powder).
• 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 absorbed by stools, making them softer and easier to pass. Examples include docusate sodium and docusate calcium.
• Lubricant laxatives: Lubricant laxatives coat the intestinal walls and stools to soften and lubricate the stools. One type is mineral oil.
• Stimulant cathartics: These medicines (Dulcolax, Sennalax) encourage movement in the intestines.

Herbal or Natural Remedies

In addition to drinking more water, eating more fiber, and exercising where possible, some natural substances may help relieve OIC. These include:

• Apricots
• Olive oil
• Products containing Sennoside (such as Senna)
• Aloe vera

Consult a health professional or pharmacist before taking herbal products because they may interact with some medicines or reduce their effectiveness.

What Are the Side Effects of Laxatives?

We generally consider laxatives safe and effective when taken as directed and for short periods. However, like all medicines, a person may develop side effects from using laxatives to treat opioid-induced constipation. The most common side effects of laxatives include:

• diarrhea
• fluid loss
• nausea
• bloating
• vomiting
• bloating
• abdominal cramps

A person taking laxatives for opioid-induced constipation should speak with their health care team if constipation symptoms do not improve or if they experience symptoms related to laxative use.

Summary

Opioid painkillers can cause constipation and other digestive problems because they reduce nervous system activity. Opioid-induced constipation is a common complaint among people taking opioids for pain relief.

Drinking plenty of water, eating high-fiber foods, and staying active where possible may help reduce this side effect.

If these natural approaches do not provide relief from opioid-induced constipation, your doctor may recommend additional treatment options such as laxatives, natural supplements, or prescription medicines.

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Our dietary recommendations for treating constipation;

1. Try to eat at the same time every day,
2. Set aside time to use the toilet at the same time every day, 
3. In addition to drinking 8-10 glasses of water daily, warm drinks should be consumed,
4. With the knowledge of the doctors managing your treatment, high-fiber foods (oats, wheat germ, prunes, pears, citrus fruits, peaches, apples, apricots, broccoli, corn, peas, tomatoes, squash, pineapple, cherries, turnips, beets, broccoli, cauliflower, carrots, almonds, lentils, onions, hazelnuts, walnuts, etc…) may be consumed,
5. Combining hot drinks and high-fiber foods at breakfast is beneficial for managing constipation, 
6. Hot lemon water may be consumed between meals, 
7. Eat small amounts frequently,
8. Every day, try to exercise, even lightly; people who cannot exercise may do exercises in bed aimed at working the abdominal muscles, 
9. Foods containing rice flour should not be consumed, 
10. If the intestines are blocked (obstruction) for any reason, your doctor will not recommend a high-fiber diet; hospitalization and stopping eating for a while may even be necessary
11. Warm or hot drinks should be consumed about 1 hour before meals, 
12. Fruit compotes should be consumed, 
13. Consuming oilseeds (nuts) also acts as a prebiotic because of their resistant starch content and increases bowel motility, so they should be consumed in the amount required daily. 
14. The fiber content of soups can be increased by adding wheat germ or oat bran, 
15. If a packaged product bought from a store has a label stating that it contains 5gr/serving of fiber, this means it is high in fiber.