Opioid-induced Constipation Treatments

What to Do about This Common Opioid Side Effect

In the United States, more than 240 million opioid prescriptions are dispensed each year. A common adverse side effect of opioids (strong pain medications sometimes prescribed to treat chronic pain conditions) is opioid-induced constipation (or OIC), which occurs in 40% to 90% of patients taking opioids.  If you’re taking opioids, your doctor should be evaluating you for any signs of OIC.  Then he or she can create a treatment plan for you to help address this opioid constipation.

Traditional OIC Treatments:  Laxatives to Lifestyle Changes
Some of the treatments used for opioid-induced constipation are the same as treatments used for “typical” constipation (called functional constipation).  You may have heard of some of these constipation treatments before, and many of them are available over-the-counter at your local drug store.

Traditional OIC treatments include:

  • Stool softeners:  These should be taken with a lot of water. These tend to make the stool “slippery,” allowing it to pass more easily through your bowel. If you find yourself straining to make a bowel movement with a lot of discomfort or difficulty, your doctor may suggest trying a stool softener.
  • Hydrating agents/lubricants:  Hydrating agents and lubricants, such as magnesium hydroxide (frequently called Milk of Magnesia) and mineral oils, work by increasing the amount of water found in stool, making it easier for it to pass through the intestine more easily. If your doctor recommends a hydrating agent or lubricant for your OIC, you can expect to have a bowel movement within the first eight hours after taking it.
  • Stimulants:  These can trigger the muscles in the intestines to contract, helping to move along your stool. However, stimulants have a tendency to irritate the lining of your intestine. Talk to your doctor if you experience any nausea, vomiting, or bowel discomfort.

In addition, it is possible that lifestyle changes may help address your OIC—specifically exercise and dietary improvements.  Eating a diet rich in fiber—such as whole grains, fruits, and vegetables—exercising on a regular basis (if you’re able to do so), and drinking plenty of water can perhaps help stimulate activity in your intestines.

Treatments for OIC vs Functional Constipation
OIC is different from functional constipation, as explained in our opioid-induced constipation overview article.  Basically, while OIC and functional constipation share similar sign and symptoms, the root cause is different:  OIC is caused by how opioids affect the nerves in the digestive tract.

Treatments specific to OIC, then, will address this root cause.  Methylnaltrexone is a prescription medication that’s currently approved for OIC; it’s available only as an injection right now, and it can be given once every other day or up to once every 24 hours (if needed).

Methylnaltrexone works like this:  opioids can have an effect on the bowel’s nerves, so methylnaltrexone protects those nerves so that opioids can’t slow down the bowel’s action.

Also, there are several clinical trials currently being conducted in the United States that are evaluating new treatments for OIC.

Currently in FDA review is naloxegol, a once-a-day tablet that is designed to block the binding of opioids to the opioid receptors in the digestive system without impacting the pain-reducing effects of opioids

The good news is that results of these trials may lead to other treatment options better suited to manage your OIC.

Updated on: 06/09/14