Powered By
Continue with Facebook
Continue with Email
Opioid-induced constipation (OIC) — trouble having bowel movements (pooping) — is a common side effect of opioid medications, such as morphine, codeine, tramadol, and oxycodone. OIC is something that people with opioid use disorder (OUD) might experience from time to time.
More than a minor inconvenience, constipation can cause ongoing discomfort and even some complications, like hemorrhoids or rectal prolapse (where the end of the large intestine stretches and protrudes out through the anus).
Fortunately, OIC is both treatable and preventable with medications called laxatives. Not all laxatives work in the same way, so it may take some time to try a few before finding one that works well for you.
Learning about different laxatives and how they work can save you time as you navigate your many options. Keep reading to learn how some of the most widely available laxatives work and what you should consider when choosing a laxative for OUD-related constipation.
OIC isn’t uncommon. Between 50 percent and 80 percent of people who use opioids experience constipation. You’re most likely to experience constipation if:
From a clinical standpoint, constipation means you either have difficulty pooping or pooping fewer than three times per week. Depending on a person’s baseline, constipation can also mean a decrease in the number of bowel movements per day or week.
Opioids can cause constipation because of the way they slow movement in your gastrointestinal (GI) tract. As a result, you have a harder time producing a bowel movement (pooping).
More specifically, opioid medications cause your intestines to take up more fluid than they normally do. As a result, the stool in your intestines becomes dry and less mobile.
Opioids can also make the muscles at the end of the bowel (the anal sphincter) stay tighter and relax less. This can make it harder to pass stool and can make you feel like you didn’t fully empty.
Most laxatives are available over the counter, so you don’t need a prescription to obtain them. When you’re in the laxative aisle at your local drugstore, the sheer number of options can feel a little overwhelming.
There’s a lot to consider when deciding which laxative to buy, including:
Laxatives work in different ways to increase movement in your digestive system so you can poop more easily or more often. Consider trying a laxative for OUD-related constipation if you’ve already tried lifestyle changes like drinking more fluids or increasing physical activity. If these strategies don’t improve your OIC, laxatives might help.
Bulk-forming laxatives, also called fiber supplements, aim to treat constipation by adding substance to your stool (making it bigger). Some common examples are fybogel and psyllium.
These laxatives are largely formed of soluble fiber, a type of fiber that draws fluid into your intestines to “bulk up” your stool. When your stool grows larger, your colon feels the difference and contracts to keep the stool moving.
Bulk-forming laxatives (fiber supplements) often don’t work well by themselves for opioid-induced constipation. In some people, extra fiber can also cause more bloating or gas, especially if you aren’t drinking enough water. Some people still use fiber as part of a plan, but many people with OIC need a different type of laxative to get real relief.
Stimulant laxatives work by activating nerves along the GI tract. These nerves control the muscles that move stool through your colon, so when they’re stimulated, those muscles start contracting. After taking a stimulant laxative, you should be able to poop within six to 12 hours.
Stimulant laxatives such as bisacodyl and senna are often the first type to be recommended to people with OIC. You can take a stimulant laxative by itself or with a stool softener to help prevent or manage OIC.
Stimulant laxatives can be helpful, but don’t take them more often than the label says. If you find you need them regularly (like most days), talk with your healthcare provider so you can find a safer long-term plan.
Stool softeners (also called emollient laxatives) may be another over-the-counter option to try. As the name implies, stool softeners work by making poop softer or more moist so it can move more easily through the GI tract. They do this by making poop absorb more water and fat.
Some providers suggest taking a stool softener like docusate along with a stimulant laxative. But for many people, stool softeners don’t do much on their own, especially once constipation is already happening.
Osmotic laxatives or osmotics help your body release more fluid into the intestine, which can help stool move more easily. Most of them take one to three days to work, which might deter you from using them if you want to poop more quickly.
Saline osmotics tend to work a little faster than other osmotic laxatives, usually leading to a bowel movement in just a few hours. These are osmotics that also include salt to help keep water in your intestine.
Yet doctors often recommend a daily osmotic laxative for OIC. Polyethylene glycol (PEG) is a common osmotic laxative people take by mouth. Glycerin is usually used as a rectal suppository.
If you decide to use osmotic laxatives, it’s important to be aware that they can cause dehydration. Drink plenty of water while taking these laxatives to reduce your dehydration risk.
Lubricant laxatives contain oils that make stool move more easily. They also coat the lining of your colon, which helps keep moisture inside to soften poop. Typically, they start working in six to eight hours.
Certain laxatives are only available with a prescription from a doctor. You may need to talk to a doctor about your prescription options if your OIC doesn’t improve with over-the-counter laxatives.
These are four prescription medications that treat opioid-induced constipation:
Your prescribing doctor will tell you how to safely take prescription medications for managing OIC in opioid use disorder.
Certain symptoms that occur with OIC could be telling you that another underlying condition is causing your constipation. Other symptoms may indicate complications of long-lasting constipation, such as rectal prolapse or fecal impaction.
Tell your healthcare provider right away if you experience:
It’s also important to tell your doctor if you have constipation with a personal or family history of colon cancer. Depending on your symptoms and history, your doctor might explore other possible causes of constipation.
If you experience OIC while using any type of opioid, talk to your doctor or opioid use disorder specialist. Your doctor can tell you more about U.S. Food and Drug Administration (FDA)-approved medications for OIC and tell you how to use different laxatives safely while managing it.
On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.
Which laxative has worked best for managing your OUD-related constipation? Let others know in the comments below.
Get updates directly to your inbox.
Continue with Facebook
Continue with Email
Continue with Facebook
Continue with Email
Become a member to get even more
Join
Your Privacy Choices
This is a member-feature!
Sign up for free to view article comments.
We'd love to hear from you! Please share your name and email to post and read comments.
You'll also get the latest articles directly to your inbox.