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Opioid-Induced Constipation – Is it Treatable?

opioid constipationOpioid drugs can cause several side effects, especially when taken in large doses. Many people who take opioid drugs for a long time, whether they take them for chronic pain due to illness or injury, or because they struggle with abuse, develop intense side effects that require treatment.

These side effects include:

  • Consistent drowsiness and sedation
  • Slowed, shallow, or irregular breathing, especially if taking too much
  • Abdominal cramps, appetite changes, and nausea
  • Constipation

 People who receive opioid prescriptions and take these medications as directed will also receive guidance from their doctor on how to manage constipation if it becomes a problem. However, people who abuse opioid drugs are at greater risk for developing chronic constipation, which can be very damaging.

How Opioid Drugs Cause Constipation

Opioid drugs bind to specific opioid receptors, which are involved in pain relief. Most of these receptors are in the brain, but a few are also bundled into the gut. Imodium, a drug created to reduce or stop diarrhea, contains a very low dose of an opioid, designed to bind specifically to the stomach’s bundle of opioid receptors.

This is why some people have started to abuse Imodium when they no longer have access to other opioid drugs.

The gastrointestinal system’s opioid receptors slow down bowel movements, so over time, even prescription doses of opioid painkillers may cause constipation. Typically, taking a laxative or stool softener, or following the physician’s recommendations for dietary changes, can reduce the discomfort from constipation. People who struggle with opioid addiction do not have access to this kind of oversight, so they are at much greater risk for long-term physical harm when they do develop constipation.

Symptoms and Effects of Opioid-Induced Constipation

Symptoms of constipation include:

  • Fewer than three bowel movements per week
  • Lumpy or hard stool
  • Straining during bowel movements
  • Feeling blocked when in the bathroom

If a person ignores these signs or struggles with addiction to opioids, these unaddressed problems can get worse. Over time, chronic constipation may cause health issues like:

  • Hemorrhoids: swollen veins in the anus, which can be uncomfortable or painful
  • Fecal impaction: stool that cannot be expelled because it has accumulated in the intestines and become stuck
  • Anal fissure: torn skin around the opening that may be painful and become infected
  • Rectal prolapse: the intestine, which has faced strain, nerve damage, and constant pressure, begins to protrude from the anus

For some people, opioid constipation may become so severe that they have to stop taking these drugs. When the individual works closely with their doctor, they can manage any potential physical dependence and associated withdrawal symptoms. A person who struggles with opioid addiction may not get help for this problem until they are sick or physically struggling.

 A detox program specializing in opioid dependence, with appropriate medical oversight to ensure the safety of the tapering process, will be able to manage chronic constipation or refer the individual to a physician who can help.

Treatment Approaches

A doctor may recommend several approaches to treating constipation, depending on how serious the problem is and how long the problem has lasted.

Basic interventions include:

  • Eating more fiber or taking fiber supplements
  • Lowering the amount of low-fiber foods in the diet, such as processed foods, dairy, and meat
  • Drinking enough water
  • Getting regular exercise
  • Finding other methods, such as mindfulness, to manage stress, which reduces strain
  • Responding promptly to bowel urges

Those who require long-term pain management with opioid drugs will likely receive prescriptions for laxatives and stool softeners. Their doctor may also recommend specific, consistent doses of a drug like milk of magnesia, which can help to manage abdominal discomfort associated with constipation.

 People who have pre-existing gastrointestinal problems and older adults are at greatest risk for constipation-caused physical problems.

Because opioids are so potent, it is important for doctors to closely monitor patients receiving these prescription medications. Thousands of people in the United States struggle with opioid addiction, most of whom developed their addiction while taking a prescription. Doctors must monitor their patients for risky side effects caused by opioids, including constipation, and must also watch for signs of addiction.


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