Opioid-induced constipation refers to constipation that’s brought on by taking opioid drugs. Constipation happens when bowel actions are rare or troublesome to go. Opioid-induced constipation is completely different from different types of persistent constipation and requires specialised remedy.
Different signs of opioid-induced constipation might embrace nausea, vomiting, bloating, and belly ache. Opioid-induced constipation is commonly handled each with drugs and way of life adjustments. This text will present an outline of opioid-induced constipation, together with widespread signs, causes, and remedy choices.
Opioid-Induced Constipation Signs
Opioid-induced constipation might begin as quickly as you start taking opioid medications or it could develop slowly whereas taking these drugs. Opioid medication are drugs used to deal with acute or persistent ache.
Frequent signs of opioid-induced constipation embrace:
Causes
Opioid-induced constipation is brought on by adjustments within the gastrointestinal (GI) tract that happen due to opioid medication.
Opioid medication have an effect on the mu receptors within the gastrointestinal tract. The mu receptors management the contraction of the muscular tissues within the GI tract, generally known as intestinal motility. When these receptors are activated by an opioid drug, intestinal motility considerably decreases. This causes the muscular tissues to decelerate and cease contracting. This results in stool staying within the GI tract as a substitute of being faraway from the physique.
Mucosal secretions within the gastrointestinal tract are additionally affected. When the secretions lower, the GI tract turns into dry, and stool can not go by way of as simply. This leads to dry, cumbersome stool that stays within the GI tract.
Opioids additionally result in elevated contraction of the anal sphincter. That is the muscle that helps to launch stool from the physique. When it’s contracted, you might discover that it feels troublesome to have a bowel motion. This results in straining and should trigger hemorrhoids.
Ought to I Keep away from Opioids?
As a result of opioid medication trigger important uncomfortable side effects, together with constipation, it is very important use them as little as attainable. The Facilities for Illness Management and Prevention (CDC) developed medical pointers to assist practitioners determine when to prescribe opioid remedy and when to hunt an alternate drug. The rules information prescribers by way of setting remedy targets, contemplating the potential advantages and dangers of remedy, and figuring out the best dosage.
Analysis and Prognosis
Opioid-induced constipation is a comparatively widespread drawback and must be thought-about any time a person takes opioid medication. It’s estimated that as much as 4% to five% of the inhabitants in the USA repeatedly takes opioid medication, and 40% to 80% of them expertise opioid-induced constipation.
Step one in making a analysis is taking a radical medical historical past. Whenever you see your physician, they may doubtless ask you in regards to the frequency and consistency of your bowel actions. They can even ask you probably have skilled ache or straining when having a bowel motion.
In response to the American Gastroenterological Affiliation (AGA), opioid-induced constipation could be identified utilizing the Rome IV definition. The Rome Basis is a not-for-profit group that develops diagnostic standards for intestine issues. In response to the Rome Basis, an individual meets the standards for opioid-induced constipation once they expertise new or worsening constipation signs when beginning or rising opioid remedy and:
- Pressure throughout greater than 25% of the time spent passing stool
- Have laborious or lumpy stools greater than 25% of the time
- Really feel as if they’re unable to completely empty all of the stool 25% of the time
- Discover the sensation of a blockage when making an attempt to go a stool
- Require guide maneuvers to go stool 25% of the time
- Have fewer than three bowel actions per week
Obstacles to Prognosis
Opioid-induced constipation is a comparatively widespread drawback however nonetheless goes undiagnosed too usually. A 2019 examine discovered that obstacles to analysis embrace:
- Physicians’ lack of understanding of the issue
- Sufferers feeling embarrassed about bringing it up
- Medical doctors feeling uncomfortable asking about constipation
- Lack of common diagnostic pointers
- Lack of particular remedy plans
Remedy and Life-style Modifications
Opioid-induced constipation often doesn’t enhance by itself and requires remedy.
Laxatives are drugs used to make having a bowel motion simpler and extra comfy. They’re thought-about first-line remedy for opioid-induced constipation. Choices embrace:
- Stool softeners work by permitting water and lipids to enter the stool within the gastrointestinal tract. This softens the stool, making it simpler to go. Docusate sodium is a generally used stool softener.
- Osmotic laxatives draw water into the gastrointestinal tract. This softens the stool and makes it simpler to go. Frequent examples embrace polyethylene glycol (PEG), magnesium hydroxide, magnesium citrate, and lactulose.
- Lubricants soften the stool by lubricating the liner of the gastrointestinal tract. This enables the stool to go by way of the tract extra simply. An instance of a lubricant laxative is mineral oil.
- Stimulant laxatives stimulate the muscular tissues within the gastrointestinal tract to contract and transfer stool out of the physique. This is called colonic motility. Examples embrace bisacodyl, sodium picosulfate, and senna.
Whereas laxatives are capable of deal with the signs of opioid-induced constipation, they don’t treatment the issue. In recent times, practitioners have begun to make use of new lessons of medication to deal with opioid-induced constipation. These medication are capable of goal the mu receptors immediately and embrace:
- Entereg (alvimopan)
- Amitiza (lubiprostone)
- Relistor (methylnaltrexone)
- Movantik (naloxegol)
Life-style adjustments that assist to ease constipation embrace ingesting extra water, rising bodily exercise, consuming fiber-rich meals, and utilizing the bathroom as quickly as you are feeling the urge to go. Whereas these way of life adjustments might assist, they often don’t relieve opioid-induced constipation on their very own.
Due to the bodily adjustments going down within the gastrointestinal tract, most people with opioid-induced constipation require laxative remedy. Enemas, a technique used to cleanse the colon, are sometimes used as a final resort when different remedy choices haven’t supplied aid.
A Observe on Fiber
Fiber is commonly considered an essential a part of stopping constipation. Fiber is a kind of carbohydrate that can not be digested by the physique. As a result of it can’t be damaged down within the gastrointestinal tract, it aids within the elimination of stool. Whereas fiber could be useful in stopping constipation, it must be used with warning in opioid-induced constipation. As a result of opioid-induced constipation causes dry, laborious stools, including extra fiber to the eating regimen might lead to belly ache and cramping with out offering any constipation aid. Any fiber complement must be taken with loads of water to make sure your physique is ready to comfortably go stool.
Prognosis
Opioid-induced constipation is brought on by taking opioid remedy and will resolve as soon as the remedy is stopped. Beginning a laxative concurrently beginning opioid remedy has been discovered to enhance and even forestall constipation.
If you can be beginning or rising the dose of opioids quickly, speak together with your physician about taking a laxative remedy. These medication are capable of relieve constipation and preserve your bowel actions common.
Coping
To deal with opioid-induced constipation, speak together with your physician about beginning common laxative remedy straight away. Ensure you are ingesting loads of water and consuming a nutritious diet with fruit and veggies. Ask your physician about what number of grams of fiber to intention for every day. Lastly, remember to use the bathroom as quickly as you are feeling the urge to have a bowel motion.
Abstract
Opioid-induced constipation is a typical drawback amongst those that take opioid medication to deal with their ache. Taking opioid remedy results in constipation as a result of these medication trigger decreased motility and mucosal secretions within the gastrointestinal tract. This results in laborious, dry stools which can be troublesome or painful to go. Remedy often begins with laxative drugs and way of life modifications reminiscent of ingesting extra water, exercising, and consuming extra fiber-rich meals.
A Phrase From Verywell
Opioid-induced constipation is a irritating and uncomfortable aspect impact of taking opioid medication. Know that it’s regular to expertise constipation when taking ache medicines, and speak together with your docs about the way to relieve your signs straight away.
Beginning a daily laxative while you start a brand new opioid remedy has been confirmed to be useful in stopping constipation points. Opioids have an effect on how your gastrointestinal tract works, so don’t attempt to repair this with way of life adjustments alone. Discuss together with your physician and get the help you want.