FAST FACTS: Bowel Management for Opioid Use

Constipation is an anticipated side effect of opioid use (opioids are a type of pain medication). When left untreated constipation may cause further pain and complications, such as stool impaction, anal fissures or hemorrhoids. Adequate bowel elimination is of particular concern for older adults as many natural body changes, as well as chronic diseases, already impact the ability of older adults to appropriately evacuate their bowels. Opioid use further complicates bowel management by slowing gastric motility. This known side effect requires preventative attention at the start of opioid therapy.  Following is information on assessment and management of constipation related to opioid use.

Important medial history -- Prior to prescribing opioid treatment, it is important to know:

• Usual frequency of bowel movements
• Routine size, color, and consistency of bowel movements
• A normal bowel movement should be easy to pass, dark brown, mostly even shaped and toothpaste-like in consistency
• Review all medications, as others can also cause constipation, including:
  • Tricyclic antidepressants. Antacids, Diuretics, Iron
  • Anti-hypertensives, Anticonvulsants, Anticholinergics, NSAIDS

Possible Interventions

• Stool Softeners (e.g. Colace, Docusate) if stool hardness is an issue to lubricate bowels
• Prophylactic laxatives should be stated when opioids are ordered and increased as opioids are increased to encourage bowel movement
• Laxatives work differently in the bowel and should be selected based on individual bowel issues:
  • Stimulants (e.g. Senna)- Trigger GI motility by irritating the intestine, usually taken at night
  • Bulk Forming (e.g. Fiber)- Absorbs water, increases bulk which distend the bowel, triggers bowel reflex
  • Hyperosmotics (e.g. Polyethylene Glycol)- Adds water to the intestine to again distend the bowel and trigger bowel reflex

What Else Can You Do:

• Document your usual bowel habits
• Request a bowel management plan if opioids are prescribed for pain