Opioid Induced Constipation – Overview and Treatment

Opioids are prescribed by doctors to treat a number of adverse health conditions including chronic pain conditions such as fibromyalgia, degenerative joint pain, severe back or knee pain, osteoarthritis, and post surgery. However, opioid usage often comes with several uncomfortable side effects including nausea, narcotic addiction, and constipation. Opioid-induced constipation is a little discussed side effect of opioid use, however, left untreated it may lead to more serious conditions such as rectal bleeding, rectal prolapse, perforation, hemorrhoids, severe abdonmial pain, anal fissures, and fecal impact. 

If you are prescribed opioids, such as tramadol, hydrocodone, morphine, oxycodone, methadone, codeine, or buprenorphine for a pain condition, constipation can come on quite suddenly with little relief. Talk to your doctor immediately to get one of the following common treatments:

1. Movantik

Movantik is an FDA-approved prescription medication prescribed to treat opioid-induced constipation and related symptoms (i.e., hard, dry, or difficulty passing stools, painful bowel movements, and stomach distension or bloating) in adults with moderate to very severe non-cancer related pain (i.e., osteoarthritis, fibromyalgia, etc.). This drug works by impeding opioids from attaching to μ-receptors within the bowel. Movantik is typically prescribed in 25-milligram dosages daily (on an empty stomach) either 1 hour prior or 2 hours following a meal, and typically works within a 6 to 12 hour duration. Patients should not take Movantik in combination with any other laxatives, and this drug should not be taken by patients with Crohn’s disease, stomach ulcer, Ogilvie’s syndrome, kidney or liver disease, or impacted stomach or bowel. Side effects when taking Movantik may include nausea, stomach pain, diarrhea, and opioid withdrawal and should be closely monitored by your doctor. 

2. Docusate 

A common over the counter stool softener option for opioid-induced constipation (OIC) can be found in Docusate (also marketed as Colace). This gentle surfactant stool softener can be taken to ease OIC or as a preventative method in patients who are prone to OIC. 

3. Senna 

Another first line over the counter OIC option is Senna (marketed as Senokot). Senna is taken orally and can safely be used daily (for the short term only) to prevent constipation, or be used as a stool softener in patients with constipation. Senna works by boosting and strengthening fecal movement via the but by slowing water absorption within the intestines. Just be careful not to take it for too long, as it reduces in effectiveness over time. 

4. Lifestyle changes

In addition to being closely monitored by a doctor and taking prescribed medications as indicated, opioid-induced constipation may also be treated with non-drug lifestyle changes such as increasing dietary soluble fiber intake, as long as the patient is not dehydrated and a bowel obstruction is not present. If the patient is found to be severely dehydrated, increased fluid intake may help. Other helpful options to ease OIC include:

  • Increased consumption of leafy greens, fruits, and whole grains
  • Daily exercise to encourage bowel movements