Opioid-Induced Constipation: The Side Effect We're Too Embarrassed to Talk About
Opioid-induced Constipation (OIC) – what no one wants to struggle with, deal with, think about, or talk about. The problem is, though, this type of constipation is one patients should feel more comfortable talking about not only with their doctors but also with their spouses/partners. This is one side effect from opioids that should never, and often can’t be, be ignored.
You may expect your meds to make you feel “dopey,” but most people never even consider their meds making it near impossible for them to have normal bowel movements. Poop is a taboo subject for most people. We all do it. It’s completely normal, but no one wants to talk about it. For healthy people, not wanting to discuss their bathroom habits is normal. Where it becomes an issue, however, is with chronic pain patients who may routinely face the struggle to use the bathroom as a result of their opioid-induced constipation. We need to be able to talk about this openly with our doctors, our spouses/partners, and maybe even each other.
I get it — talking about the inability to poop normally, or needing to tell someone that the effort makes you feel as if you are being ripped apart, can be a difficult and embarrassing subject. Chronic pain patients get the short end of the stick all too frequently. We need pain medication on a daily basis to function, but taking that pain medicine slaps us with a bunch of side effects that alter our quality of life. Then on top of that some of us are slapped with another severe pain problem caused by constipation from taking the very medicines that help us wake up, get dressed, do chores, go to work, and attempt to lead halfway “normal” lives. Saying it isn’t fair is an understatement.
In an article on CNBC titled, “No Joke — Opioid Constipation Drugs are Serious Business,” analyst for global data Claire Gibson states, “Anywhere from 40 to 90 percent of opioid users as some point experience OIC.” That’s a lot of people! Any guesses on how many of those people initially neglected to tell their doctors about it? Even if your doctor is new to your condition, they most likely have encountered patients with OIC before and will know how to help you handle it. Crossing your fingers and hoping it goes away isn’t the answer.
So why do opioids cause constipation? The “No Joke” article explains this disaster by first explaining that the way opiates tackle pain is the same way the opiates make bowel movements more difficult. In our bodies, there are receptors called “mu-opioid receptors.” These receptors take in the opiate and bind with the medication to help calm the pain signals. Unfortunately, these receptors are also included in the makeup of our intestinal tract, and they forge a strong bond with the tract that has a great impact on the bowels’ ability to function properly, causing constipation. It’s likely that some patients will try taking more opiates to cope with the pain involved with running to the bathroom, not realizing this only compounds the problem. Another fun side effect of OIC that increases the pain felt are hemorrhoids, caused by constantly straining to poop. Hemorrhoids develop from swollen veins near the rectum and can cause bleeding in addition to pain and an itchy feeling. Needless to say, everything involved with OIC is dreadful.
What Can Be Done About OIC? Talking to your doctor will help you determine the best plan of action. Some people may disagree, but I also believe that talking about the issue with your spouse/partner can be really helpful in dealing with this problem. They may have questions anyway if you’re screaming every time you go to the bathroom. Being open with your spouse/partner can help them be better caregivers (if that is one of their roles) and more informed in general about your chronic pain condition and its affect on your life.
Your doctor may suggest one or more of the following to try yourself before looking into prescription meds that specifically target opioid-induced constipation.
- More fiber in diet — You can add more fiber to your diet by taking pills, mixing powder in with meals, and eating high fiber foods, but fiber just adds more substance to the stool. It doesn’t affect the opiate-receptor binding problem.
- Laxatives — Laxatives are slow acting meds that promote bowel movement. In a clinical trial study published in 2014, researchers found that laxatives don’t fully address the constipation caused by opiates. Which makes sense. Laxatives work by increasing the amount of fluid in the bowels to help things move along. They don’t change the binding of the receptors caused by the opiate medication. So, while they may help a patient pass stool, the laxatives aren’t actually fixing the real problem.
- Stool Softeners — slow acting, softens hard stool to make it easier to push through (Sometimes combining laxatives and stool softeners can overcorrect and cause diarrhea.)
- Exercise — promotes bowel movement
- Drinking lots of water
Be prepared to try what your doctor suggests, but remember it can’t hurt to do your own research. If you think an OIC targeted medication is something worth trying, talk to your doctor about it. Targeted medication works by focusing on the receptor binding in the intestinal tract without affecting the opiate-receptor relationship, which is what helps make it more successful than other over-the-counter remedies. It is possible that the targeted medication is one they haven’t heard of, have very little experience with, or don’t think is right for you. Talking with them about it will help you figure out why it hasn’t been mentioned before and will also help you advocate for your needs.
Advocating for Yourself
Talking to your doctor about your options is the first step. The next step is learning how to track your constipation so you can have a more informed conversation with your doctor and know more about your body. Plus, in the event of any emergency, more information about your condition is always better than too little information. Nothing is irrelevant. The American Chronic Pain Association offers two OIC tracking methods on their website. One is a print out with various questions including how many times a week you take prescription opiates, how many glasses of water you drink a day, how bad it hurts to go, and more. The second is an online tool, great for people with smartphones who want to have their medical information on the go. Another helpful tool may be to create your own tracker spreadsheet logging each bowel movement, how much pain it caused, when it happened, medication you were on at the time, and more depending on what details you and your doctor feel are important to record. The U.S. Pain Foundation recently posted a link to a survey on opioid-induced constipation that I recommend anyone with OIC should take to promote more research and encourage open discussion about the issue.
Opioid-induced constipation can be painful, difficult to deal with, and embarrassing for even the bravest of pain warriors. It’s OK to need help. It’s OK to go to your spouse/partner and say you need to tell them something awkward about your condition. They won’t love you any less for being constipated (hopefully), and will be a hand to hold to make you feel more confident when discussing this with your doctor. So many of us live in constant, debilitating pain every day. We shouldn’t have to deal with one more pain-inducing problem like OIC. Be brave and change the taboo surrounding conversations about bowel movements.
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