Self-Care for Opioid Induced Constipation

Because of the likelihood of constipation when taking opioid pain medications, many health care providers recommend one or more self-care techniques as soon as patients begin taking the medication—even if constipation has not yet developed.

Patients who take pain medication and have already developed constipation may also find relief by employing one or more of these self-care techniques.

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These techniques may include, but are not limited to:

Exercising. Regular exercise can help alleviate constipation. Exercise increases circulation, which in turn stimulates the bowel muscles, helping to accelerate the movement of stool through the colon, Stretching and yoga can also make the bowel muscles more pliable. In addition, exercise can also help reduce chronic pain, which may reduce the need for opioid analgesics. While patients with arthritis may find some types of exercise difficult, there are many types of gentle exercise they may find accessible, such as water exercise, yoga, tai chi, or walking on a treadmill.

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Drinking plenty of water and other non-caffeinated fluids, at least 40 ounces per day. Water helps to relieve constipation by keeping stool soft and hydrated as it moves through the intestines. It helps keep the intestinal tissue healthy as well. Dehydration is a major cause of constipation, and dehydration combined with the use of opioid medication can lead to substantial constipation. Caffeine can also contribute to dehydration. It is crucial to drink lots of water during and after exercise to prevent dehydration.

Eating several small meals a day, rather than a few large ones. It is easier for the body to digest smaller meals, which in turn can relieve constipation. Frequent small meals can also help relieve the nausea that sometimes results from taking opioid pain medication.

Avoiding fatty, processed meats and fast foods, such as bacon, sausage, hamburgers, cheese, and processed snacks such as cookies and potato chips. Highly processed and fatty foods are more difficult to digest, and can aggravate both constipation and the nausea that may accompany opioid pain medication use.

Eating natural laxatives, such as prunes and prune juice, apple cider (not apple juice), bran cereals, watermelon, grapes, apricots, rhubarb, carrots, spinach, broccoli, asparagus, lettuce, raisins, and whole grains can keep the digestive system working efficiently. Adding legumes and nuts such as black or pinto beans, chick peas, walnuts, and peanuts and also healthy oils such as olive oil, flaxseed oil, or grapeseed oil to the diet can also help alleviate constipation.

Increasing fiber intake. The USDA’s current recommended intake of fiber for adults is between 25 to 38g per day, but one average people consume 15g or less.¹U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. Washington, DC: U.S. Government Printing Office, 2010. http://www.dietaryguidelines.gov. Accessed January 20, 2015. For patients taking opioids it is even more important to include sufficient dietary fiber to keep the digestive system healthy. Many of the above-mentioned natural laxatives are high in fiber. Patients can also increase fiber intake by not peeling the edible skins off fruits and vegetables (e.g., apples, potatoes), because the skin is often the most fiber-rich part of these foods. Please note that patients who are nearly or completely immobile, as is the case for some people with severe arthritis pain, should consult their doctor before increasing fiber intake.

Taking a fiber laxative. Over-the-counter fiber laxatives such as Metamucil, Perdiem, and Citrucel work by bulking up stools, which also has the effect of bringing more water into the intestines. These laxatives are generally considered safe to use, and work for most people. Patients can also try adding fiber supplements to their diet, such as over-the-counter fiber pills (e.g., Fibercon) or chewable fiber gummies. However, some patients who take opioid pain medications may find that fiber laxatives actually worsen constipation, especially if they are dehydrated and/or have poor nutritional intake.²McKay SL, Fravel M, Scanlon C. Management of constipation [clinical practice guideline]. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Translation and Dissemination Core; 2009.

Using a stool softener, gentle over-the-counter laxative, or combination product. If the above options haven’t worked, patients can try using an over-the-counter stool softener, such as Colace, or a mild laxative such as milk of magnesia, Senokot, Dulcolax, or Miralax. However, patients are advised to use some of these products with caution, because the body can become dependent on these supplements. For example, patients who overuse them may no longer be able to produce bowel movements without taking laxatives. In rare cases, these products may cause electrolyte imbalance. Stool softeners alone are generally safer to use in high doses than laxatives or combination products.

Using suppositories or enemas. These two types of treatments are inserted directly into the rectum. Over-the-counter suppositories such as glycerin and Dulcolax work by stimulating muscle contractions in the colon, and usually produce quick results. Over-the-counter enemas work by injecting fluid (usually saline) into the colon to help liquefy stools and stimulate the bowels. Both of these treatments should be used only once, and if they don’t produce results, patients are advised to seek medical care.

Patients are advised to consult their doctor if the above self-care techniques do not produce results within a few days, or if their constipation is severe.