6+ Things to Try to Help With Opioid-Induced Constipation

As a part of your overall care plan, you may take opioids to lower pancreatic cancer-related pain. One common side effect of these medications is constipation. This is when you have fewer than three bowel movements a week that are hard, dry, lumpy, painful, or difficult to pass. 

When you take an opioid, movement in your stomach and intestines slows. This means your body absorbs medications more slowly. The slowdown allows your intestines to reabsorb more water. This makes your poop harder and more difficult to pass. Opioids also cause a tightening of the muscle at the end of the anus (which makes it harder to go to the bathroom) and slow the release of certain fluids that help digestion.

Many people resort to fiber to ease constipation. But if you already get enough fiber (25-30 grams per day) in your diet, adding more won’t ease OIC. If you eat too much fiber, you can actually make your symptoms worse. Too much fiber can cause a bowel obstruction, which is a medical emergency that involves a blocked intestine. Too much fiber in your diet can also cause stomach discomfort, gas, and make it hard for your body to absorb important nutrients.

Some common stool softeners (like Colace) and bulk-forming laxatives (like psyllium) won’t help with OIC. But others might give you some relief. Stimulant laxatives (like senna and bisacodyl) make the muscles in your intestines contract more. This helps waste move through your digestive tract more quickly. You might need a higher dose for OIC, so it’s best to ask your doctor before you use one. Osmotic laxatives pull water into your intestines. This softens poop and helps it move easier. But some types can be dangerous. Ask your doctor about the different types and if one may be a good fit for you.

Treating opioid-induced constipation starts with hydration. Before you try any other treatment, make sure you’re drinking enough water and getting a good balance of electrolytes. Ask your doctor if you’re unsure if your electrolyte levels are normal. They can tell you how much water you should be drinking and give you tips on what sports drinks, supplements, or types of food can help you get a proper electrolyte balance.

There’s not a lot of data that shows exercise can help ease the symptoms of OIC, specifically. But there is information on how exercise can help typical, everyday constipation. Doctors tend to use this information to help people with the opioid-related version. Physical activity can help waste move through your colon faster by boosting movement in your intestines. Adding just 30 to 60 minutes of activity to your routine each day can help.

In some cases, you may need extra help from your doctor. They may suggest peripherally acting μ-opioid receptor antagonists (PAMORAs). These can help ease constipation related to opioids without blocking the pain relief you get from them. There are a few different kinds. Naldemedine can help you to go poop faster. But serious side effects have been reported, especially in cancer patients. Methylnaltrexone and oral naloxone can help you use the bathroom about 24 to 30 hours after treatment. Naloxegol can boost stomach and intestinal movement. It can help you even if you don’t respond well to laxatives, and it doesn’t have many side effects.

Your doctor may also give you other medications like linaclotide, lubiprostone, and prucalopride.

There are a few other things that may help ease the symptoms of OIC. Along with medication, hydration, fiber, and exercise:

• Schedule your bathroom breaks so that you create a routine for your body.
• Stay away from heavy meals and fatty foods.
• Mix 4 to 8 ounces of warm prune juice with milk of magnesia and drink.
• Drink warm liquids during or after a meal.

While these things may not fully treat your symptoms, they could offer some relief for OIC.

It’s important to stay away from certain things when you have OIC. You can worsen your symptoms or cause other issues:

• Never hold in the urge to go to the bathroom.
• Don’t take more medication (like laxatives) than your doctor told you to take.
• Avoid fiber supplements unless your doctor tells you to take them.

Don’t wait until you’re constipated to take a laxative. Instead, your doctor will create a schedule for when to take them.

When in doubt about what to do or how to treat your OIC, call your doctor and ask questions. If you haven’t pooped in more than three days, call your doctor right away. Don’t stop taking your opioids during this time. Your doctor will be able to guide you to feeling better. They’ll help you find a treatment that can ease discomfort and pain.