Medical Treatments for Opioid Induced Constipation

There are a number of medical interventions available for treatment of constipation associated with opioid pain medications. Healthcare providers can be more helpful when patients provide as much information as possible, such as:

• Schedule and dosages of opioid and other medications
• Amount of daily water intake and exercises
• Number of bowel movements in a week

Change in Medication Dosage or Type

A healthcare provider may wish to review the patient’s current over-the-counter anti-constipation medications to suggest changes in dosage. Or providers may recommend several medications in combination for better results.

Patients can also speak to their doctor about possibly reducing the dosage or frequency of the opioid medication, or making adjustments to other medications that may be contributing to their constipation.

Partial or full substitution of opioid pain medications with another non-opioid medication may help alleviate constipation. Common non-opioid pain medications include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Motrin, Advil, Nuprin), naproxen (Aleve, Naprosyn), or cox-2 inhibitors (Celebrex)
• Aceteminophen (Tylenol)

If reduced opioid dosage does not alleviate constipation, or if patients are not currently able to stop taking opioid pain medications, further medical intervention may be warranted.

Prescription Medications to Treat Constipation

Healthcare providers may prescribe one or more medications to treat constipation that has not responded to self-care techniques or reduction in opioid dosage. Which medication(s) patients receive will depend on the other medications or supplements they are currently taking, their age, and other medical risk factors.

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Prescription medications that can alleviate constipation include, but are not limited to:

• Lubiprostone (Amitiza), a selective chloride channel activator that works to loosen the stool, and is FDA-approved for the treatment of chronic constipation.
• Linaclotide (Linzess), a drug that stimulates the cells lining the small intestine to release fluid into the intestine, loosening stools and increasing the number of bowel movements.
• Colchicine, a drug designed to treat gout, but can also produce loose stools.
• Misoprostol (Cytotec), a drug primarily used to treat stomach ulcers, but can also produce loose stools. (Use of this drug to treat chronic constipation remains controversial.)
• Orlistat (Xenocal), a weight-loss drug that blocks fat absorption, but can also produce loose stools. This drug may be a good choice for chronically constipated patients who are also overweight, ¹ Guarino AH. Treatment of intractable constipation with Orlistat: a report of three cases. Pain Med 6. (2005) Jul-Aug; (4):327-8. though its use overall remains controversial.

Other Medical Treatments for Constipation

Biofeedback, in which a physician inserts an electronically enabled catheter into a patient’s rectum, which transmits a signal to a screen indicating contraction of rectal muscles. By visually monitoring the patient’s ability to contract and relax his or her rectal muscles, the physician can help train the patient to develop better bowel-movement control.

Electrical pacing, in which small electrodes are implanted into the muscular wall of the colon, which then periodically stimulate the colon to produce bowel movements. This treatment is currently considered experimental.

Surgery, which is only used for life-threatening complications of constipation. In this surgery, called a colostomy, all or part of the colon may be removed, and the small intestines or remaining part of the colon is surgically attached to the rectum, or attached to an external bag.

While it is understandable for one to feel reluctant to talk about the subject of constipation, it is a common problem for anyone taking opioids and physicians are aware of many options to provide relief.

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