What to Use for Opioid-Induced Constipation

Opioid-induced constipation is a common problem for people prescribed opioids as well as people who commonly misuse them. It is generally treated or prevented with either a stimulant laxative and stool softener or an osmotic laxative. 

Certain other changes, such as increasing fiber and fluid intake, can also help to prevent and alleviate constipation. If you are prescribed opioids or for those experiencing constipation while on Suboxone, talk to your doctor about how to best avoid this potential side effect.

What Is Opioid-Induced Constipation?

Opioid-induced constipation (OIC) is a type of constipation caused by opioid use. It is very common among patients on opioids:  40% to 60% of people on chronic opioids report constipation. [1]

Because OIC is so common, prescribers will often preemptively prescribe laxatives alongside many opioid prescriptions to reduce the chance that an individual develops the issue and to lessen its severity if it does occur. 

Beyond laxatives, there are a few other ways a patient can further reduce their risk of constipation and the severity of their constipation if it occurs.

Laxatives That Help With Opioid-Induced Constipation

The following are some different laxatives that can help with opioid-induced constipation. Most laxatives are quite safe, but you should always talk to a doctor before taking them. 

Stimulants (Senna/Bisacodyl)

Stimulant laxatives work by stimulating muscles in the bowels, allowing your body to pass waste more easily.[2] This type of laxative is quite safe and can be purchased over the counter without a prescription. 

Osmotic Laxatives (Polyethylene Glycol)

Osmotic laxatives are a type of laxative that helps to hold water in stool in order to soften it.[3] They are also often quite safe and can be purchased over the counter. 

Stool Softeners (Docusate)

Stool softeners are products designed to soften stool, making it easier to pass, usually taken before bed.[4] The most common stool softener used for combatting OIC is docusate. 

Stool softeners, osmotic and stimulant laxatives can all be taken together, and they can work synergistically if one agent is not sufficient on its own. 

Other Ways to Reduce Constipation

These are some other ways to reduce constipation, which can often be primarily combined with laxatives:

Fiber

A diet rich in fiber – found particularly in fruits and leafy green vegetables – helps to move stool along the digestive tract. A diet rich in fiber is ideal, but if dietary fiber is insufficient, you can also purchase fiber supplements, although these have not been shown to work better than dietary fiber alone. 

Fluid Intake

Good fluid intake can help to soften stools, making them easier to pass. It’s also important to stay hydrated when using laxatives, as they can often increase the amount of water your body is using and potentially cause issues related to dehydration if not supplemented with better water intake.

Exercise

Exercise helps to keep the body healthier and can strengthen the muscles involved in bowel movements, making it easier for the body to pass stool. Doctors often recommend that patients walk regularly if they are experiencing issues with constipation.

Weighing Risks vs. Benefits of Opioids

On a basic level, the best way to prevent opioid-induced constipation is to talk to a doctor about the possibility of OIC and follow their recommendations. 

Only take opioids as prescribed, and talk with your doctor if you think you’re taking more opioids than you need to get the pain relief you require to be functional. Opioids have a place in medicine and pain management, but they also carry a number of risks when used long term beyond just OIC, so they should only be taken when necessary. Most doctors will recommend patients first try non-opioid pain management and then take the lowest opioid dose needed to manage their pain.

When to Talk to Your Doctor

Usually, OID is an uncomfortable but non-life threatening side effect. However, in extreme cases the constipation can be severe or even lead to bowel obstruction. If you experience nausea/vomiting, inability to pass gas, or extreme abdominal pain, this may be a more serious sign of a problem. You should discontinue your opioids if possible and speak to your doctor.

Sources

1. Opioid Induced Constipation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK493184/. January 2022. Accessed December 2022.
2. Bisacodyl. UK NHS. https://www.nhs.uk/medicines/bisacodyl/. June 2021. Accessed December 2022. 
3. Don’t Bomb the Bowel With Laxatives. Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/dont-bomb-the-bowel-with-laxatives. March 2022. Accessed December 2022.
4. Stool Softeners. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a601113.html. August 2018. Accessed December 2022.