Opioid Induced Constipation

When you experience a decrease in the frequency of bowel movements and find it difficult to pass stools, you may have constipation. To resolve the issue properly, you need to identify the underlying cause first. It could be primary constipation caused by certain lifestyle factors, such as bad eating habits, decreased physical activity, or inadequate fluid intake. It could be secondary constipation caused by pathologic changes such as intestinal obstruction. Certain medications may also cause constipation, for example, opioid can cause constipation. 

How Does Opioid Cause Constipation?

Opioids bind to mu-opioid receptors in your central nervous system to produce analgesia, but they also bind to receptors in the gastrointestinal (GI) tract. When opioids bind to mu-opioid receptors in the GI tract, it results in slow intestinal movement, which in turn leads to constipation. 

What Are the Symptoms of Opioid Induced Constipation?

If you have been taking an opioid medication for quite a long time and are having less than three bowel movements a week, you may have developed opioid induced constipation. However, there are some other symptoms to consider. For instance:

  • You may have OIC if you pass dry, hard stools, and it can be quite painful at times.
  • You may have a feeling of incomplete evacuation if you have OIC.
  • You may have nausea and vomiting when you have OIC.

Home Remedies for Opioid Induced Constipation

It is possible to take certain steps and use home remedies to prevent and treat opioid induced constipation. Here are some suggestions.

1. Mind Your Diet

Your diet will have a huge impact on your health, and what you eat will also affect the health of your gastrointestinal tract. Here are some steps to take:

  • Be sure to drink plenty of water. You should drink at least 40 ounces of water and other non-caffeinated fluids every day. Water keeps your body hydrated and keeps stool soft. It is also essential for the health of your intestinal tissue. Combined with opioid medication, dehydration usually results in substantial constipation. Be sure to drink non-caffeinated fluids because caffeine will make your condition worse.
  • Eat small meals throughout the day instead of a few large ones. This will help your body digest food easier. You are less likely to feel nauseous when having frequent small meals.
  • Eliminate fatty, processed food and meats from your diet. Do not eat sausage, bacon, cheese, hamburgers, and processed snacks such as potato chips and cookies because your body takes a lot of time to digest these foods. Improper digestion will aggravate opioid induced constipation.
  • Include natural laxatives in your diet. Your diet should include apple cider, prunes, watermelon, bran cereals, rhubarb, apricots, grapes, spinach, carrots, asparagus, broccoli, raisins, lettuce, and whole grains because they work as natural laxatives. Including healthy oils such as flaxseed oil, olive oil, and grape seed oil in your diet will also help alleviate constipation.
  • Add more fiber to your diet. You should consume at least 25-38g of fiber everyday, and you may need more fiber when you are taking opioids. Be sure to eat fruits without peeling the edible skins off because they contain the highest amount of fiber. You can also consider taking a fiber supplement.

2. Do Exercises

Only changing your diet may be not enough, you'd better make an effort to have a healthier lifestyle. You should exercise regularly to improve your digestive health. Regular exercise helps increase blood circulation that in turn stimulates the bowel muscles and ensures proper movement of stool through the colon. Try yoga and stretching to help make your bowel muscles more pliable. Staying active will also help reduce the need for opioid analgesics because regular exercise may help reduce chronic pain. You can try water exercises or simply walk on a treadmill.

Medical Treatments for Opioid Induced Constipation

When home remedies do not work, you can try medical treatments. Here are some options:

1. Over-the-Counter Medications

You can find many OTC medications to relieve constipation symptoms. For instance:

  • Stool softeners: To avoid straining while trying to have a bowel movement, you can take stool softeners that change the consistency of your stool and make it easier to pass through the intestine. Be sure to drink plenty of water when taking stool softeners.
  • Lubricants and hydrating agents: You can use lubricants and hydrating agents to add more water content to your stool, which in turn will make your stool softer and ensure that it passes through the intestine without any problem.
  • Stimulants: You can always try stimulants to let the stool pass easily. The stimulants encourage tightening of the muscles in the intestinal wall, which helps propel the stool forward. Talk to your doctor before trying stimulants because they can inflame your intestinal lining.

2. Prescription Medications

When OTC medications do not work, you may have to try prescription medications for relief. Here is what your doctor may prescribe:

  • Methylnaltrexone bromide: This peripherally acting opioid antagonist is a common choice to treat patients who do not respond well to usual laxative therapy. It works as an antagonist in the GI tract mainly because it can't cross the blood-brain barrier, therefore it can help treat constipation without damaging centrally mediated analgesia.
  • Naloxone: Usually used in combination with oxycodone, naloxone helps treat and prevent OIC. It has a low bioavailability when taken orally and only binds to peripheral opioid receptors in the GI tract. This helps regulate the functioning of your gastrointestinal tract and prevent OIC.
  • Alvimopan: This peripherally acting antagonist can block the peripheral effects of opioids on the GI tract, therefore helps with constipation.
  • Lubiprostone: This selective chloride channel-2 activator helps treat OIC by stimulating the small intestine, which in turn helps produce more fluid in the gut and promote gut mobility as well.

Note: It is important to talk to your doctor before you start taking any OTC or prescription medications to treat your OIC. 

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