Constipation is a common opioid side effect. This medicine slows bowel movements moving through the intestine. This may cause the stool to become hard and difficult to pass. Or, you might have a normal bowel movement, but only every few days. This side effect won’t go away on its own but can be treated with laxatives. Constipation from opioid medicine does not go away on its own.
This handout will review how to prevent and treat constipation from opioids. Please discuss your constipation plan with your doctor or nurse.
Ways to Prevent Constipation
Prevention is key. The goal is to have a soft bowel movement that is easy to pass daily or every other day. The best way to prevent constipation is to start taking a laxative every day when you start the opioid medicine. Keep taking laxatives every day for as long as you are taking opioids. Do not wait until you get constipated to take a laxative. You can get these laxatives without a prescription:
Senna: Take 2 tablets once a day (recommended).
Polyethylene glycol (MiraLAX) Stir 1 capful in one cup (8 ounces) of water and drink daily.
Please remember: Stool softeners such as docusate (Colace) are not laxatives and do not relieve constipation from opioids.
Symptoms
Sometimes constipation happens even if you have tried to prevent it. Symptoms include:
Hard stools
Going several days without bowel movement
Cramping
Bloating
Nausea
Loss of appetite
Treating Constipation
If you have symptoms of constipation:
Increase your laxative dose.
Increase Senna dose by taking 2 tablets of senna twice a day.
Add a daily dose of polyethylene glycol (Miralax) with Senna.
Add another laxative. If you haven’t had a bowel movement in 2 days, add another laxative on day 3.
Take a dose of milk of magnesia or half a bottle of magnesium citrate.
Use a bisacodyl suppository. If you need a suppository, please tell your care team.
Do not take more than 4 tablets of senna daily without talking with a doctor, nurse or pharmacist.
Diet
It’s important to have a well-balanced diet.
Drink six to eight 8oz glasses of water.
You may drink up to one cup of prune juice each day.
Include foods rich in fibers.
Avoid fiber supplements unless told to take them by care team.
Listen to your body after mealtime when the colon is most likely to be active.
Some people add 4-8 oz of warm prune juice to their milk of magnesia find that helpful. This is sometimes called a “Brown Cow.”
Activity
Increase physical activity. Moving on your feet can improve bowel function.
When to Call
If you have not had a bowel movement for over 3 days, please call your doctor or nurse. Do not stop taking your opioids.