Why do opiates cause constipation

Medically reviewed by Alan Carter, Pharm. How do opioids cause constipation? Other digestive problems Other causes Takeaway Opioid use can lead to constipation. Share on Pinterest Opioid pain relief can cause constipation and other digestive problems as they reduce nervous system activity. Other digestive problems. Other causes of constipation.

Share on Pinterest Increasing fluid intake can help to relieve constipation. Latest news Adolescent depression: Could school screening help? Exposure to air pollutants may amplify risk for depression in healthy individuals. Related Coverage. What to know about constipation. Medically reviewed by Stacy Sampson, D. What to know about constipation after surgery. Medically reviewed by Elaine K. Phases I and II studies confirmed that methylnaltrexone bromide antagonised opioid-induced gastrointestinal effects, including decreasing gastric emptying time and increasing oral-caecal transit time.

Moreover, a meta-analysis of patients from palliative care settings enrolled in two randomised controlled studies calculated an odds ratio for the primary outcome of a rescue-free bowel movement within four hours versus placebo of 6.

The odds ratio of a rescue-free bowel movement within 24 hours was 5. However, in one randomised clinical study, patients taking methylnaltrexone reported an increase in pain 3.

However, the authors did not report whether this reached statistical significance [ 27 ]. The difference observed in pain after 14 days between the placebo and methylnaltrexone groups was largely due to a reduction in pain within the placebo group.

Common adverse effects associated with methylnaltrexone bromide include abdominal pain, flatulence, nausea, dizziness, and diarrhoea. Methylnaltrexone bromide is contraindicated in known or suspected mechanical gastrointestinal obstruction [ 28 ]. Furthermore, patients with localized or diffuse reduction in the structural integrity of the gastrointestinal tract wall e. An oral combination of oxycodone and naloxone—indicated to treat severe pain—might help prevent OIC. In a double-blind randomised control trial, the times to pain events inadequate analgesia were significantly shorter in the placebo group i.

The maximum difference in BFI score was recorded at four weeks: As mentioned above, a score under Moreover, These benefits appear to be maintained in the long term. Mean BFI score improved from The combination of oxycodone and naloxone is associated with a range of common adverse effects, including constipation, nausea, vomiting, diarrhoea, and abdominal pain.

Meissner and colleagues confirmed the suggestion that naloxone accounted for the increase in the incidence of adverse events [ 33 ]. In general, however, adverse events associated with oxycodone plus naloxone tend to be mild to moderate and the incidence is often similar to placebo [ 29 , 30 ].

Vondrackova and colleagues, for example, reported that 8. The incidence of diarrhoea was 5. Patients with severe renal impairment require careful monitoring. These properties allow alvimopan to block the peripheral effects of opioids on the GI tract, without reversing centrally mediated analgesia. However, results are not consistent among all the studies. Another study of patients with chronic cancer pain did not find any increase in the frequency of bowel movements with doses of 0.

Consequent to these disappointing phase III data, further development of alvimopan to treat OIC was discontinued [ 38 ]. Lubiprostone is a selective chloride channel-2 activator that acts locally in the small intestine leading to an increased fluid secretion and gut motility. The first trial reported a significant increase in spontaneous bowel movements at eight weeks and also overall for the entire week study period.

The mean number of spontaneous bowel movements per week increased from 1. However, the second trial did not show a significant increase in bowel movements in response to lubiprostone, according to the limited information available from the public website of the drug manufacturer [ 39 , 40 ].

The limited data that exists for this drug led to the conclusion, by a recent meta-analysis, that more trials are required before a definitive recommendation can be made on the use of lubiprostone in OIC [ 41 ].

Despite alleviating severe acute and chronic noncancer pain, opioids are underprescribed due to concerns about addiction and side effects [ 3 ].

However, in some cases, people with severe OIBD limit use of or discontinue opioids, to alleviate the additional pain and discomfort associated with OIBD [ 13 ]. OIC management can encompass nonpharmacological and pharmacological approaches.

However, nonpharmacological measures alone seldom successfully control OIC symptoms but can be combined with pharmacological options [ 19 ].

Currently, there is a consensus that laxative treatment should commence with the opioid therapy and continue throughout treatment, although this is not routine. Even when concurrent laxatives are prescribed, approximately half of patients treated for OIC do not achieve the desired improvement [ 13 ].

Moreover, laxatives do not target the underlying cause of OIC-opioid binding to the receptors in the enteric system and as such are not very effective at managing OIC. The failure of lifestyle modification and aggressive laxative therapy to treat OIC symptoms led to the development of analgesic formulations that include peripherally acting opioid antagonists.

Judicious use of the various options to manage OIC should allow more patients with severe noncancer pain to benefit from opioid analgesia. Although the safety and efficacy of opioid antagonists have been proven in several studies, none of the previous studies has established an improvement in quality of life with increased passage of bowel movements. This is a significant deficiency that needs to be addressed in the future studies. Anton Emmanuel has served on advisory boards for Mundipharma and Napp.

Lalit Kumar has no conflict of interests to declare. This work was commissioned by Napp Pharmaceuticals Limited that did not actively contribute to the content but reviewed for scientific accuracy. The authors would like to acknowledge the assistance of ROCK medical communications in the preparation of this paper.

This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Get some tips here on precautions and treatment.

Obstipation is when a person cannot pass stool or gas, usually due to an obstruction or blockage of hard, difficult-to-pass stool. Here are 5 herbal remedies to ease your symptoms. The list of opioids is long. Learn their forms, factors used in choosing them, and tips for taking them safely. A new survey by Orlando Health finds that most people would rather use alternatives to opioid pain medications if better options were available. Learn how Imodium can help ease diarrhea from withdrawal, as well as facts about treating other symptoms.

The Hulu series "Dopesick" uses fact and fiction to detail the rise of OxyContin and how the Purdue Pharma drug ignited the opioid epidemic. Experts say healthcare professionals need to be aware of a person's risk of opioid addiction before surgery is performed.

Health Conditions Discover Plan Connect. Medically reviewed by Lindsay Slowiczek, Pharm. Medications Natural remedies Home remedies Takeaway Opioid-induced constipation Opioids, a type of prescription pain medication, can trigger a specific type of constipation known as opioid-induced constipation OIC.

Opioid drugs include pain medications such as: oxycodone OxyContin hydrocodone Zohydro ER codeine morphine These medications are effective because they block pain signals by attaching to receptors throughout your nervous system.

Opioid-induced constipation medication. Natural remedies for opioid-induced constipation. Home remedies for opioid-induced constipation. The takeaway. Read this next. Over-the-Counter and Prescription Constipation Medications. Medically reviewed by Alan Carter, Pharm.

Managing Constipation After Surgery. Medically reviewed by Debra Sullivan, Ph. Opioids are painkillers containing a substance chemically similar to the alkaloids that are found in the opium poppy.

Prescription medications that contain opioids include methadone , Percocet , Vicodin , Demerol , Dilaudid , and fentanyl. They are prescribed for pain relief, usually for acute pain such as after an injury or surgery, but also for long-term pain such as that caused by cancer.

In some cases, opioids are used to treat diarrhea, usually in quite small doses to avoid potential side effects. Studies have shown that many physicians do not know their patients are experiencing constipation when receiving opioids. Virtually all patients receiving opioids report having digestive side effects. Up to 40 percent may have constipation. Constipation occurs when stools are infrequent, hard, and difficult to pass. In general, having healthy bowel movements could mean going anywhere from three times a day to three times a week.

However, a change in bowel movements may indicate constipation. Opioid-induced constipation is different than constipation that is functional. Functional constipation could be from a variety of causes ranging from not enough fiber in the diet to a disease or condition in the digestive tract.

Opioid-induced constipation, however, is a direct result of the way that opioid medications affect the small intestine and the colon , by slowing down digestion. Opioids have several different effects that slow down digestion. In the stomach, opioids can cause gastroparesis , which means that the stomach takes longer to empty than it should because the muscles are not working effectively.

Food moves through the small intestine because of muscle contractions known as peristalsis. Opioids affect the middle of the small intestine jejunum by increasing circular muscle contractions, which are non-propulsive contractions, and this decreases the peristalsis that normally moves food along.

This can also create harder stools, making them more difficult to pass. Opioids also affect how the anal sphincter responds to the drug. When stool is in the rectum, there is a natural urge to go to the bathroom and pass it. Overall, these effects on the digestive system mean that some people will experience constipation when using opioids. For people who need long-term pain management with these medications, this can be a significant problem.

Treatment for opioid-induced constipation could include both lifestyle changes and medications. The approach to treatment depends heavily on the current state of your health as well as other factors such as the medications. In many cases, lifestyle changes and over-the-counter laxatives are not effective enough to provide complete relief. Making some changes to your everyday routine, along with other treatments, may help with constipation.