Treatment of constipation caused by opioid pain relievers

This is an automatically translated article.

The article was consulted with Specialist Doctor I Dong Xuan Ha - Gastroenterologist - Department of Medical Examination & Internal Medicine - Vinmec Ha Long International General Hospital.
An opioid pain reliever is a prescription medication that is commonly used to relieve pain in cancer patients. Opioid-induced constipation can be a side effect that many patients complain of. Some clinically common opioid analgesics are oxycodone (OxyContin), hydrocodone (Zohydro ER), codeine, and morphine.

1. Why do opioid pain relievers cause constipation?

Opioid analgesics work by blocking pain signals by competitively binding to receptors throughout the nervous system. Interestingly, these receptors are also found in the body's intestinal system. When opioid pain relievers bind to receptors in the gut, the time it takes for stool to pass through the digestive system is lengthened.
Constipation is defined as having fewer than three bowel movements per week. Statistics show that between 41 and 81% of people who take opioids for long-term pain relief, excluding cancer patients, are constipated.

2. Some medications for opioid-induced constipation

There are medications that can help people feel more comfortable by reducing symptoms.
Over-the-counter drugs
Stool softeners: these drugs work to increase the amount of water in the large intestine and make stools easier to pass. Peristalsis stimulants: These stimulate bowel movements by increasing contractions. Osmotic laxatives: Osmosis helps increase the amount of fluid moving through the large intestine. These include oral magnesium hydroxide and polyethylene glycol. Mineral oil is a lubricating laxative that also helps stool move more easily through the large intestine. It is available as an oral and rectal pump. An enema or suppository inserted into the rectum can soften stool and stimulate bowel movements. However, they also carry the risk of damaging the rectum if inserted incorrectly. Prescription drugs
Prescription drugs are specific to opioid-induced constipation, so they are likely to treat the root of the problem. These drugs block the effects of opioids on the intestinal tract and make stools easier to pass. Drugs approved to treat opioid constipation include:
Naloxegol Methylnaltrexone Lubiprostone Naldemedine However, this class of prescription drugs can also cause side effects, such as:
Nausea Vomiting Headache Diarrhea Bloating Talk to your doctor if you experience side effects while taking this medicine. Your doctor may have to change the dose of the medicine or switch to a different medicine.

3. Home remedies for opioid-induced constipation

A number of supplements and herbs can relieve opioid-induced constipation by stimulating bowel movements, including:
3.1 Fiber supplements Fiber has a laxative effect because it increases absorption water in the large intestine. This forms a molded stool and helps the stool pass more easily. Although fiber supplements are an effective remedy for constipation, more research and surveys are needed to confirm the effectiveness of fiber supplements for opioid-induced constipation.
Fiber can be a treatment for opioid-induced constipation, but it's important to drink plenty of water while taking a fiber supplement. If you don't drink enough water, dehydration can make opioid-induced constipation worse.
Daily fiber needs should be maintained at an average of 25 to 30 grams. Include a variety of fiber-rich foods such as fruits, vegetables, and whole grains into your daily diet. Great food sources of fiber include:
Plums Raisins Apricots Asparagus Beans Too much fiber can cause diarrhea and upset stomach. Therefore, it is important to gradually increase the amount of high-fiber foods in your diet.
Fiber supplements may decrease the absorption of some medications such as aspirin. Talk to your doctor before combining fiber supplements with any prescription medications.
3.2 Aloe Vera Supplement Aloe vera may also relieve opioid-induced constipation. In one study, rats were given loperamide to induce constipation. They were then treated with aloe vera at the following doses for seven days: 50, 100, and 200 milligrams (mg) per kilogram of body weight. The study found that rats that received aloe vera extract had improved bowel movements and stool volume. Based on research, aloe vera's laxative effect can improve drug-induced constipation.
Consult your doctor, pharmacist before using aloe vera. This type of food can reduce the effectiveness of some medications, such as:
Cholesterol-lowering drugs Certain hormonal drugs

3.3 Senna Supplement Senna is a species of yellow flowering plant. Its leaves have a laxative effect that can help relieve opioid-induced constipation naturally.
Senna supplements are available in capsule or tea form. You can buy dried senna leaves from the grocery store and brew them in hot water. Or you can buy sennosides (Senokot) tablets from the grocery store or pharmacy.
The usual starting dose for adults is 10 mg to 60 mg per day. Children should take a smaller amount of senna, so read the product label instructions carefully for the recommended dosage.
Senna should be used for short-term support of opioid-induced constipation. Long-term use can cause diarrhea and electrolyte imbalance. This herb may also increase the risk of bleeding when taken with warfarin (Coumadin), an anticoagulant.
3.4 Increase physical activity Exercise and physical activity stimulate contractions in the intestinal tract and promote bowel movements. Get 30 minutes of exercise most days of the week. Talk to your doctor before starting a new exercise routine.
3.5 Drink lots of water Dehydration makes it difficult to have a bowel movement. Drink 8-10 glasses of fluids per day. Replenish water in a variety of drinks such as filtered water, tea, juice.
3.6 Ice or heat therapy Constipation can cause bloating and abdominal pain. Applying a warm or cold compress to the pelvic area can help relieve discomfort.
3.7 Eliminate irritating foods from your daily diet Processed, high-fat foods that are hard to digest can make opioid-induced constipation worse. Limit your intake of trigger foods, such as fast food and junk food.
In summary, although opioids can effectively relieve your pain, you still run the risk of constipation while taking these drugs. If lifestyle changes, home treatments, and over-the-counter medications aren't providing the desired results, talk to your doctor about prescriptions to help regulate your bowel movements. .

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