Opioid constipation is the most common and perhaps the most severe side effect of opioid analgesics. The worst thing is that opioid constipation does not tend to go away with drug use, but increases and thus gradually reduces the patient's quality of life. Check how to cure opioid constipation.

Opioid constipationis the most common and probably the most severe side effect for patients from taking opioid painkillers - most often morphine administered orally in the form of tablets. Among patients treated with opioids, the most frequent complaints are those with neoplastic disease. It is estimated that 70-90 percent of them struggle with them. treated oncologically.

Opioids have a number of side effects. The early side effects of taking these types of medications include drowsiness, nausea, and vomiting. Later they are joined by constipation and other digestive ailments. Therefore, constipation is part of the so-called the syndrome of intestinal disorders that occurs during the administration of opioids (also known as opioid intestinal disorders, opioid bowel syndrome).

Rare side effects include sweating, dry mouth, confusion, balance disorders, urinary retention, itchy skin, and hallucinations.

Opioid constipation - causes

Opioid analgesics act on the opioid receptors in the intestinal wall and disrupt their function, slowing down peristalsis (in medical terminology, this process is called poopioid intestinal paralysis). As a consequence, the movement of undigested food debris in the intestines is difficult, and sometimes even impossible. In the intestines, the content of the food becomes dehydrated and then becomes hard, which in turn leads to the formation of fecal stones.

Opioid constipation - symptoms

The patient complains that the frequency of bowel movements is too low (3 per week) or the stools are hard, passing with effort, often accompanied by a feeling of incomplete bowel movement.

In addition, there may be other symptoms that make up the Opioid-Induced Bowel Distress Syndrome such as stomach fullness, gas, loss of appetite, gastroesophageal reflux disease, heartburn, abdominal pain, nausea, vomiting.

Otherspossible accompanying symptoms include dyspnoea, dizziness and arrhythmias.

Opioid constipation - treatment

The Group of Experts of the Polish Society of Palliative Medicine has proposed the following procedure in the case of opioid constipation:

  • drugs that are typical and commonly used in constipation (stimulating the peristalsis of the large intestine, softening the stool, osmotic agents). Unfortunately, traditionally laxatives are of little use in reducing constipation caused by opioid medications;

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  • methyln altrexone administered by subcutaneous injection (except for concomitant oral medications);
  • a combination preparation containing a combination of an analgesic (oxycodone) with an opioid receptor antagonist (naloxone). The latter drug binds to the same receptors in the gastrointestinal tract as opioid drugs and thus takes their place. At the same time, this preparation does not penetrate the intestinal barrier and does not enter the blood or nervous system, so it does not block the analgesic effect of opioid drugs. The combination of oxycodone and naloxone is available in a fixed ratio of 2: 1 in 5 / 2.5 mg, 10/5 mg and 20/10 mg tablets;

Often the only way to get rid of constipation is to manually remove the stool mass. If that doesn't work, you may need to go to the hospital. Rectal enemas are then used. As a last resort, an operation may be necessary.

If side effects occur, the patient may ask the doctor to switch from one opioid to another. As a last resort, he may give up this group of painkillers and use other drugs.

Opioid constipation and a diet rich in fiber

An important role in the treatment and prevention of opioid constipation is played by a diet rich in fiber (20-30 g / day), because it retains water in the intestinal lumen, forms fecal masses and stimulates peristalsis by filling the intestine. However, some experts note that fiber may not help and may even be counterproductive for opioid constipation. All because of drug-induced intestinal paralysis, which increases the weight of the stool, which is even more deposited. As a consequence, more fiber intake can make constipation even worse.

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Category:

Gastrology