Opioids and Constipation: Understanding the Connection (& Treatment)

Prescription opioids are used to treat all kinds of pain symptoms, but even when they are taken as directed, they come with side effects. Constipation is a common adverse effect that comes from taking an opioid, and doctors usually take steps to avoid or remedy the issue. 

However, people who are stuck in a pattern of opioid addiction may experience this uncomfortable symptom on top of other harmful consequences of opioid abuse. Still, it’s important to address chronic opioid abuse and constipation. It may not be as harmless as you think it is.

Learn more about why opioid-induced constipation can be dangerous and how it can be treated.

What Is Opioid-Induced Constipation?

Opioid-induced constipation (OIC) is a significant issue for people who are being treated with opioid medications and for people who have opioid use disorders. Constipation may seem like a relatively mild side effect of a chemical substance, but it can lead to serious medical complications if left untreated. Constipation can lead to hemorrhoids, fissures, rectal prolapse, and fecal impaction.

In severe cases, constipation can lead to digestive issues and even serious problems like ulcers and colitis.

Constipation is particularly challenging for people who are being treated with opioids for chronic conditions like chronic pain or cancer. In treatment settings, your doctor may start you with one laxative at the same time you start treatment with an opioid to prevent constipation. It can also be treated later after constipation develops. In some people, it’s an immediate side effect while other people develop it slowly over time. OIC can lead to secondary issues like bloating, nausea, vomiting, abdominal pain, and straining.

For both licit and illicit opioid users, constipation is a common hurdle that needs to be addressed in treatment to ensure a comfortable and healthy experience. Like many unaddressed issues

Why Constipation Can Be Dangerous

Constipation can lead to a variety of ailments that cause discomfort and even painful symptoms. If you’re going through addiction treatment or detox, even small discomforts can cause stress and anxiety. If this is piled on top of drug cravings and withdrawal symptoms, it could hurt your treatment progress and even threaten your sobriety. For that reason, don’t be afraid to let your doctor or medical team know about any discomfort your experiencing. In addiction treatment, your physical health is a top priority. It can be difficult to focus on therapy when you have an upset stomach or other uncomfortable but treatable issues.

But opioid-induced constipation can be more dangerous than you may realize, especially among older people. Besides the bloating and discomfort, straining because of constipation can cause some pretty serious complications. Here some of the rare but dangerous consequences of straining:

Blood pressure spikes.

Straining can cause a sudden rise in blood pressure that can be dangerous in some situations. People who have heart-related issues, people who have recently had heart surgery, and older people are particularly vulnerable to complications like strokes from blood pressure spikes.

Aneurysm.

High blood pressure pikes can also lead to weakened blood vessels, which can burst, causing an aneurysm.

Drop in blood pressure.

Some people use a technique called the Valsalva maneuver to force pressure into the body. This method means holding a deep breath and straining. Proponents believe this will help them unclog their ears, nose, and even bowels. During the strain, blood pressure will increase, but it can cause irregular heartbeats. This, coupled with holding your breath, can cause a sudden drop in blood pressure, which can cause you to lose consciousness and collapse. Fainting can be dangerous, especially in bathrooms with hard porcelain and sharp marble edges.

Why Opioids Cause Constipation

Your brain can sense pain all over the body in the brain, bones, muscles, and organ tissues. Opioids receptors are designed to bind with endorphins to mitigate pain, so they, too, can be found all over the body in the spinal cord, peripheral neurons, and digestive tract. There are four major subtypes of opioid receptors in the body, but one of them (mu opioid receptors) are located in the intestinal tract. Opioids like heroin, morphine, codeine, and many prescription opioids, are mu opioid receptor agonists, which means they bind to and activate their receptors.

Opioids stop pain and relax the central nervous system in a way that slows it down. When intestinal opioid receptors are activated, it can cause the nerves in your bowels to be suppressed, which lowers their motility (ability to move independently). It literally lowers your ability to move your bowels. If food can’t move through the digestive system efficiently, it can cause constipation and even become impacted.

Treating Opioid-Induced Constipation

Though opioid constipation can be uncomfortable and lead to some pretty serious complications, it’s generally an easily treatable problem. Constipation is an incredibly common problem in the United States, but there are home remedies you can try. If you’ve stopped taking an opioid, but you still have clogged plumbing, here are some things you can do in your day to day life to get moving:

• Drink more water. Keeping hydrated can help soften your stools to help them pass more easily. It also helps issues like impaction.
• Eat more fiber. Fiber is found in things like wheat bran, barley, vegetables, whole grains, nuts, seeds, beans, lentils, and peas. Insoluble fibers like veggies and grains add bulk to your stools while nuts, seeds, and beans absorb water and form a gel that softens stools.
• Exercise. Some studies have shown that exercise doesn’t increase bowel movements, but some say that it can help relieve symptoms in people with irritable bowel symptoms. Though the results are mixed, exercise can a variety of benefits, so it’s worth a try.
• Drink coffee. Caffeine is a central nervous stimulant, and it can even stimulate the muscles in the digestive tract. Decaffeinated coffee can be 23 percent more effective than water at stimulating your gut, and caffeinated coffee is 60 percent more effective.
• Eat probiotic food or supplements. Your gut is full of bacteria, and it’s supposed to be. Gut flora is an important part of digestion and helps to break down your food. People with bowel problems often have imbalances in their gut bacteria. Constipation can be bad for your gut, but diarrhea can also cause you to kill or flush out good bacteria. If you’ve recently gone through opioid withdrawal and detox, you may have dealt with flu-like diarrhea. Probiotic foods like Greek yogurt or probiotic supplements can help your gut bacteria recovery.
• Over-the-counter laxatives. Several different types of over-the-counter laxatives might be able to help you. Some are fiber-based while others contain stimulants or oils.

If you are taking an opioid or struggling with opioid use disorder, you may need help treating side effects like constipation. If you think you might be addicted, the best approach would be to address your substance use problems. When you enter addiction treatment, you will complete a medical assessment to determine your immediate needs. Mention to your doctor that constipation is causing discomfort. Going through detox may be all it takes to normalize your digestion, but if it continues to bother you, your doctor may prescribe medications to help ease your symptoms.

Sources

Chin A Paw, M. J., Van Poppel, M. N., & Van Mechelen, W. (2006, July 31). Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: A randomized controlled trial. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16875507/

Rao, S. S., Welcher, K., Zimmerman, B., & Stumbo, P. (1998, February). Is coffee a colonic stimulant? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9581985

Serrano Falcón, B., Barceló López, M., Mateos Muñoz, B., Álvarez Sánchez, A., & Rey, E. (2016, January 11). Fecal impaction: A systematic review of its medical complications. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709889/

Sikirov, B. A. (2004, April 21). Cardio-vascular events at defecation: Are they unavoidable? Retrieved from https://www.sciencedirect.com/science/article/pii/0306987790901282