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Opioid bowel syndrome is an intestinal disorder that is one of the side effects of opioids - painkillers, without which it is currently difficult to imagine pain management without opioids. What are the symptoms of opioid bowel syndrome and how is it treated?
Opioid bowel syndrome , oropioid bowel disorders , is the most common undesirable symptom of opioid drug use. Opioids work at different levels in the digestive system. They inhibit the kinetics of the stomach, leading to an increase in the time of gastric emptying. In the case of the small intestine, propulsive contractions are inhibited, more water is absorbed from the intestinal lumen, and the passage of food itself is prolonged. The large intestine is exposed to inhibition of propulsive peristalsis, and what is more, the tension in the anal sphincter increases, while reducing the sensitivity of the rectum to stretching. The effect of these measures is to extend the transit time and increase the water absorption, which in turn leads to the formation of hard stools and too few bowel movements, and the need for them is reduced. These are the main symptoms of the opioid bowel syndrome. These disorders, caused by opioid drugs, most often relate to palliative therapy and affect 70-90% of patients. patients with oncological problems who are administered the aforementioned drugs.Opioid bowel syndromemost often accompanies treatment with morphine, although when taking other opioids they should be treated in the same way - as a typical undesirable effect.
Opioids - what is that?
Opium is a naturally occurring substance obtained from dried milk juice, which is produced by immature poppy seeds. Opium includes compounds - alkaloids. Their further division will lead us to names such as morphine, codeine or a drug that has been used successfully in medicine for a long time. Opioids are primarily a group of painkillers. Their action is based on an appropriate interaction with opioid receptors. Stimulation of all receptors causes an analgesic effect, i.e. analgesic, but also leads to actions that are undesirable for our body. The main activities that we would like to avoid in this case are: drowsiness, analgesia, mood changes, respiratory depression,nausea and the most common of them - weakening of the gastrointestinal motility.
Opioid Bowel Syndrome - Treatment
In the case of opioid treatment, measures to prevent constipation should be implemented from the very beginning. Treatment of opioid bowel syndrome mainly boils down to treating constipation caused by factors other than opioid medications.
The basic action against constipation is a balanced diet rich in fiber. Fiber, which keeps water in the intestinal lumen, participates in the formation of fecal mass and stimulates peristalsis. in vegetables, fruit or dark bread. It is also important to drink enough fluids. The following are favorable here: water, juices (except grapefruit), as well as yogurt and kefir.
Another factor supporting the functioning of our intestines is physical activity. Unfortunately, treatment with opioids usually affects people who are immobilized or have reduced mobility, so exercise is recommended (whenever possible).
Laxatives are another way to fight opioid gut disorders. We can distinguish several types here:
- osmotic agents - accelerate the intestinal transit, increase the volume of fecal mass reaching the colon and its stretching, and further accelerate defecation. The healing effect appears after 2-3 days, but you should be careful with the so-called the effect of tolerance and the appearance of colic or diarrhea;
- stool softeners - increase the volume of the intestinal mass while softening it, which results in easier expulsion;
- irritating agents - they increase intestinal peristalsis thanks to the stimulation of the intramural ganglia and increase the secretion of water and electrolytes through the intestinal mucosa. The efficacy of laxatives with opioid treatment is limited. It is preferable to take drugs that irritate and increase the volume of fecal masses at the same time.
Another method of fighting opioid bowel syndrome are lubricants that coat the walls of the intestine with paraffin, as well as enemas - the rectal application of the enema causing the effect of defecation.
These are some of the most common methods of fighting opioid bowel syndrome. In the event of their ineffectiveness, it is necessary to manually remove the stool, which is a painful procedure that requires the administration of painkillers beforehand.
Opioid bowel syndrome is a significant problem for mainly oncological patients whose treatment is based on opioid drugs. This has an impact on their quality of life and, unfortunately, is often not taken into account.The diagnosis of constipation should be based on taking into account all possible causes and their further treatment. Opioid bowel syndrome should be combated by traditional methods, while taking into account opioid receptor antagonists.