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Opioids and Constipation

Even when opioid drugs are taken as prescribed by a doctor, constipation can be a side effect. It can be very uncomfortable, and if left untreated, it can harm the intestines.

Report constipation from prescription painkillers to your doctor, so they can manage your overall medical treatment better.

People who struggle with opioid addiction are less likely to seek any medical intervention for this side effect. It can result in long-term damage as a result.

Opioid Use

Opioids are a class of drugs that can relieve pain by binding to opioid receptors in the brain. This halts pain sensations, and it can also release dopamine and serotonin to create feelings of happiness and relaxation.

Prescription opioids like oxycodone, hydrocodone, and codeine play important roles in pain management in modern medicine, but they are also very addictive. Other opioids, like heroin, are so addictive that they are no longer prescribed and are totally illegal in the United States.

This class of central nervous system (CNS) depressants is very addictive. The U.S. Centers for Disease Control and Prevention (CDC) reports that an average of 130 people die daily in the U.S. as a result of opioid overdoses, most of which occur from abusing heroin, fentanyl, and similarly potent opioid drugs. However, many people misuse and abuse these drugs without overdosing or dying. While they may not have encountered opioid toxicity, they likely deal with side effects from narcotics, including constipation.

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How Do Opioid Drugs Lead to Constipation?

Opioid drugs are, for the most part, intended to bind to opioid receptors in the brain. These drugs are often taken orally, especially when they are taken as prescribed by a doctor, so they may also bind to other opioid receptor sites in the body.

There are more opioid receptors in the spinal cord and the gastrointestinal tract. When opioids are taken orally, they move through the stomach and intestine to be released into the bloodstream. Along the way, they may bind to the cluster of opioid receptors in the gastrointestinal system.

Some mild opioid drugs use the gastrointestinal opioid receptor sites to manage digestive problems instead of pain. For example, loperamide is a mild opioid medication that is still sold over the counter (OTC) in the United States, frequently under the brand name Imodium. 

Loperamide was designed to control diarrhea, which could be caused by several underlying conditions. When opioids bind to the gastrointestinal opioid receptor sites, involuntary muscle movements in the small intestine slow down.

Constipation is one of the most frequently reported side effects among people who abuse higher doses of opioids, who consistently abuse opioids, or who do not get help from their overseeing physician if they develop side effects from their opioid pain medication.

Constipation is defined as three or fewer bowel movements per week. Everyone will experience constipation once in a while in life, but when it does not go away, gets worse, or harms your health, you need to seek medical treatment.

Constipation Symptoms and Risks

Signs of opioid-induced constipation include the following: 

  • Dry, hard stool
  • Difficulty defecating
  • Pain or straining to defecate
  • Constant feeling of needing to use the bathroom
  • Bloating, bulging, or distension in the abdomen area
  • Abdominal tenderness
  • Feeling nauseated, tired, or sick
  • Vomiting
  • Lethargy
  • Depression
  • Loss of appetite

When left untreated, constipation can lead to fecal impaction, blood in the stool from internal bleeding, and weight loss. You may also develop an iron deficiency, or anemia, which can lead to feelings of dizziness and weakness.

Other serious health complications associated with chronic constipation include: 

  • Hemorrhoids, or swollen veins in and around the rectum, which may bleed or cause pain.
  • Anal fissure, or torn skin around the anus that can become infected.
  • Fecal impaction, or a hardened stool that becomes lodged in the intestines and prevents further bowel movements.
  • Rectal prolapse, or damage to the muscles inside the rectum, leading to the smooth muscles protruding out.

While not all of these health problems require emergency attention, they do require medical attention. They can quickly lead to worsened health outcomes if left untreated.

Treating Constipation May Require Opioid Addiction Treatment

If constipation symptoms are new, and you take painkillers as directed by your doctor, you may be able to use home-based treatments while your doctor adjusts the dose of your medication to reduce side effects. Home remedies include: 

  • Eating foods high in fiber
  • Drinking more water
  • Taking fiber supplements
  • Exercising more, if possible

Your doctor may also recommend over-the-counter medications to ease constipation, like: 

  • Laxatives, which increase the amount of water in the intestines
  • Lubricants or emollients, which soften stool and lubricate the bowels
  • Stimulant cathartics, which promote intestinal movement
  • Prostaglandins, which change how the intestines absorb water, and electrolytes to promote movement

There are prescription versions of these medications available as well, which are helpful for people who take larger doses of opioid painkillers to manage chronic pain.

Methylnaltrexone bromide is the first opioid antagonist that can act on peripheral opioid receptors, like those in the gastrointestinal system.

This means that people who need prescription opioid painkillers, or a withdrawal management treatment like methadone, can still benefit from the medication but experience less constipation.

Frustrated man sitting on a toilet

If you misuse prescription painkillers or struggle with addiction to opioids, you may struggle with constipation, which can lead to serious health problems if it is untreated.

While getting help from a doctor for OTC or prescription laxatives or stool softeners can help in the short term, it is important to get help overcoming opioid abuse through addiction treatment. This reduces harm from physical problems in the long term.

Sources

(March 21, 2018) What are Opioids, and Why are They Dangerous? Mayo Clinic. Retrieved April 2019 from https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/what-are-opioids/faq-20381270

(December 19, 2018) Opioid Overdose: Understanding the Epidemic. Centers for Disease Control and Prevention (CDC). Retrieved April 2019 from https://www.cdc.gov/drugoverdose/epidemic/index.html

(October 26, 2018) What is Opioid-Induced Constipation? Medical News Today. Retrieved April 2019 from https://www.medicalnewstoday.com/articles/323430.php

(January 30, 2018) FDA Drug Safety Communication: FDA Limits Packaging for Anti-Diarrhea Medicine Loperamide (Imodium) to Encourage Safe Use. U.S. Food and Drug Administration (FDA). Retrieved April 2019 from https://www.fda.gov/Drugs/DrugSafety/ucm594232.htm

(January 10, 2018) Constipation. Mayo Clinic. Retrieved April 2019 from https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253

(April 1, 2019) Opioid Induced Constipation. StatPearls. Retrieved April 2019 from https://www.ncbi.nlm.nih.gov/books/NBK493184/

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