5 Signs You May Have Opioid-Induced Constipation and How To Treat It

Constipation is a common and often unexpected challenge of managing opioid use disorder (OUD). Being constipated means it’s hard to have a bowel movement (poop). When constipation is caused by opioid use, it’s called opioid-induced constipation (OIC). Almost everyone who takes opioids has some level of constipation as a side effect.

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If you take opioids, constipation can sneak up on you. OIC is not just uncomfortable — it can affect your daily life and lower your quality of life. Keep reading to learn about the common signs of OIC and the treatments for OIC that can help.

Why Do Opioids Cause Constipation?

Opioids work by binding to proteins called opioid receptors. When opioids bind to opioid receptors in the central nervous system (brain and spinal cord), they can result in pain relief and create feelings of pleasure. But these opioid receptors are also found in other parts of the body, including the gastrointestinal (digestive) tract.

When opioids bind to opioid receptors in your gastrointestinal tract, they slow down the natural movement of the intestines (called peristalsis). Peristalsis pushes stool through the bowels. When this movement slows, stool stays in the intestines longer. This allows more water to be absorbed, making the stool hard and dry.

Opioids also make it harder to feel when your rectum (the last part of the colon) is full. That means you may not notice the urge to poop. At the same time, opioids can tighten the muscles around the anus (the end of the rectum, where stool exits the body), making it harder to pass stool. This is why constipation is one of the most common side effects of opioids.

5 Signs of Opioid-Induced Constipation

OIC can look different for everyone. Some people notice signs of OIC right away when they start taking an opioid. For others, symptoms of OIC develop slowly and lead to chronic constipation. Either way, OIC is a change from your usual bowel habits before starting an opioid.

You don’t need to have all of these signs to have OIC. Having two or more within a three-month period may be a warning. Knowing the signs of OIC can help you catch the problem early and get the right treatment.

1. You Have Fewer Than Three Bowel Movements a Week

Constipation means having fewer than three bowel movements per week. This is also true for OIC. Normal bowel patterns are different for everyone, ranging from three times a week to three times a day. With OIC, you may notice a big drop from your usual pattern.

When you’re taking an opioid, your stool moves more slowly through your intestines, and it’s harder to feel the urge to have a bowel movement. That means bowel movement without the help of medications (called spontaneous bowel movement) may happen less often.

2. Your Stool Is Hard or Lumpy

Another common sign of OIC is having hard or lumpy stool. This happens because opioids slow the movement of your stool through your intestines, increasing how much water your body absorbs. This creates a dry, hard stool that’s painful and difficult to pass.

Healthcare providers use the Bristol Stool Form Scale to classify stool into seven types, from watery diarrhea to very hard stool. In OIC, at least 1 in 4 stools may look like small pebbles (type 1) or a lumpy log (type 2). Diarrhea (type 6 or type 7) is uncommon in OIC unless laxatives are used.

3. You Have To Strain To Have a Bowel Movement

When your stools are hard and difficult to pass, you might feel like you have to push hard to have a bowel movement. People with OIC need to strain to have a bowel movement in at least 1 in 4 bowel movements.

4. You Still Feel Like You Have To Go Right After a Bowel Movement

OIC can make it feel like your bowels didn’t empty all the way. Even after a bowel movement, you might still feel pressure or the urge to go again. If you experience this feeling in at least 1 in 4 bowel movements, this could be a sign of OIC.

5. Constipation Doesn’t Improve When You Change Your Diet

Constipation is very common and can often be managed at home with some simple dietary and lifestyle changes. A high-fiber diet is a common treatment for constipation. Fiber adds bulk to the stool and helps the stool hold water, which makes it easier to pass.

Eating more fiber may not help with the treatment of opioid-induced constipation. Fiber adds bulk to stool but does not change how fast stool moves through the intestines. In OIC, the main problem is slower intestinal movement, so even bulky stools can be hard to pass.

When To Seek Medical Attention for Constipation

When constipation is severe, it can cause serious complications. If you have any of the following symptoms, you should seek medical attention right away:

• Severe abdominal pain
• Vomiting
• Black stools or red blood in your stool
• Blood on your toilet paper
• Sudden changes in your bowel habit

You should also talk to your healthcare provider if constipation lasts more than three weeks, if symptoms make daily life hard, or if you’ve lost weight without trying.

Treating Opioid Induced Constipation

Once OIC develops, it can be difficult to manage. Treatment and management of opioid-induced constipation usually involves a combination of lifestyle changes and medications.

Opioid Use Disorder Treatment

For people living with OUD, treating the disorder itself can ease constipation while also supporting recovery.

Treatment for OUD often includes medication-assisted treatment (MAT) with medicines such as buprenorphine or methadone. These medications help reduce cravings and withdrawal symptoms, making recovery safer and more manageable. Over time, MAT may reduce opioid use, which can also improve side effects like constipation in people with OUD.

Gradually tapering off opioids under medical supervision can help the digestive system return to normal. Always follow the instructions of your healthcare provider. Stopping opioids suddenly is not safe and can cause withdrawal symptoms.

Treatment for OUD goes beyond medication. Counseling, peer support, and behavioral therapy are also key. These approaches address the physical, emotional, and social aspects of opioid use disorder while helping improve your quality of life.

Talk to your healthcare provider about treatment options for OUD and how they may support both your recovery and your digestive health.

Lifestyle Changes

Healthy lifestyle habits are an important part of prevention and treatment of OIC. Important lifestyle changes for OIC include:

• Increasing fluid intake
• Increasing fiber intake to 25 grams to 30 grams per day
• Avoiding food rich in fat
• Getting regular exercise
• Going to the toilet as soon as you feel the urge to have a bowel movement

If you add more fiber to your diet, be aware that it may cause side effects like bloating and flatulence (gas). This happens because opioids slow the movement of fiber through your digestive system. In some cases, too much fiber can make constipation worse and even cause a bowel obstruction (blockage). Most people with OIC should avoid fiber supplements like psyllium (Metamucil), to reduce the risk. Talk to your healthcare provider about safe ways to add fiber to your diet.

Medications

Laxative medications are usually the first medicines recommended for OIC. Different types of laxatives work in different ways to improve stool frequency and consistency, making it easier to have a bowel movement.

Over-the-Counter Laxatives

Over-the-counter (OTC) laxatives that may help with OIC include:

• Stool softeners — These add moisture to stool to make it easier to pass. Docusate is an example of a stool softener.
• Osmotic laxatives — Thes pull water into the intestines to soften stool. Examples include polyethylene glycol, magnesium hydroxide, and magnesium citrate.
• Lubricant laxatives — These coat stool and the intestinal lining so stool moves more smoothly. Mineral oil is an example.
• Stimulant laxatives — These activate nerves that control the muscles in the intestines, helping stool move. Examples include senna and bisacodyl.

Even though these laxatives are available without a prescription, talk to your healthcare provider before using them for OIC.

Prescription Laxatives

If OTC laxatives don’t work, your healthcare provider may suggest prescription treatments. Peripherally acting mu-opioid receptor antagonists (Pamoras) are medications approved to treat OIC. They block the effect of opioids in the gastrointestinal tract. Examples include methylnaltrexone, ​​naloxegol, and naldemedine.

Other prescription laxatives that may be helpful for OIC include lubiprostone and prucalopride. However, these medications aren’t specifically approved for OIC.

Your healthcare provider can help you decide which lifestyle changes and medications are best for preventing and treating OIC.

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What has helped you treat opioid-induced constipation? Let others know in the comments below.