Americans suffer from many bowel issues with constipation being on the top of the list. We can blame our diet, inactivity, not enough fluids, mechanical problems, and pain medication but whatever the reason, constipation all to often affects our daily living. There is a relatively new terminology describing a very specific type of constipation called Opioid induced constipation. OIC is a result of taking opioids for chronic pain relief Nurses General Nursing Article
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Constipation is usually the result of multiple other problems and should not be taken lightly. It is especially common in the elderly, the very young, and female patients. Constipation is diagnosed by several symptoms such as hard stools, straining, and several days between bowel movements. If you were thinking that constipation is only prevalent in the U.S., think again. According to the article, "How to Manage Chronic Constipation in Adults," by June Rogers MBE, Europe has up to 81% of patients with complaints of constipation. Also, in England, 12 millions prescriptions were written for laxatives in 2001.
As mentioned before, constipation affects daily living. Rogers references a study in her article done in 2011 that says constipation lowers quality of life, patients had a higher incidence of employment absenteeism, as well as being less productive at work. Below is a way that healthcare professionals rate symptoms of constipation.
Rome III criteria: At least two symptoms need to be present for the preceding 6 months (Muller-Lissner, 2009).
There are many drugs that can cause constipation such as anticholinergics like scopolamine. Tricyclic antidepressants, phenothiazines, iron, bismuth, calcium channel blockers along with many more contribute to patients suffering from constipation.
Opioids are pain relievers that mimic morphine working on the opioid receptors. Some examples are: hydrocodone, fentanyl, oxycodone, and naloxone. Opioids always causes constipation, so much so that prophylaxis should be started when the opioid is. In the article, "Management of Opioid Induced Constipation," it tells us that fiber, fluids, stool softeners are encouraged but not enough for these patients.
The above mentioned treatments may not be enough, or even possible for some patients. One thing the physician should do is prescribe a laxative or cathartic as soon as the opioid is given. Peter Crosta tells us in his article, "All About Opioids and Opioid-Induced Constipation (OIC)," all of the types of drugs used to treat OIC:
Another route the doctor may choose to help the patient's OIC is "rectal intervention" if the above medications have not worked. Rectal intervention is the use of enemas and rectal suppositories, rectal irrigation and manual evacuation.
There are new medications for the treatment of OIC that you may have seen on television commercials. One of those drugs that specifically targets OIC is Methylnaltrexone or Relistor. Relistor is given subcutaneously and "displaces the opioid from binding to peripheral receptors in the gut, decreasing the opioid constipating effects and inducing laxation." Because Relistor has a restricted ability to cross the blood-brain barrier, only the peripheral opioid receptors are antagonized in the gastrointestinal tract. Therefore, it does not reverse the effects of the opioid pain pill.
An oral option for OIC is the relatively new drug called Movantik. September of 2014 the FDA released a study done by the U.S. Food and Drug Administration showing patients experienced an increased number of bowel movements. Some mild side of effects of Movantik are headache, excessive gas, diarrhea, and abdominal pain. The FDA is requiring further study on the cardiac effects of this medication.
Alvimopan (Entereg) is used to decrease the development of an ileus post operatively in patients having a bowel resection, partial colectomy, and hysterectomy but does not decrease the effectiveness of morphine.
There are many side effects to most medications, creating the need for even more medication to treat them. For those patients taking opioids, the new medications now available allows patients to poop and still have good pain control. Have you had patients taking these medications for OIC? Please share your experiences.
References
"All About Opioids and Opioid-Induced Constipation (OIC)." Medical News Today. 23 March, 2016. Web.
"FDA Approves Movantik for Opioid-Induced Constipation." 16 September 2014. U.S. Food and Drug Administration. 24 March, 2016. Web.
"Management of Opioid Induced Constipation." Sept. 2011, ED. 3. UWHealth Pain Care Services. 23 March, 2016. Web.
Rogers, June MBE. "How to Manage Chronic Constipation in Adults." Vol. 108:No. 41. 10 Sept. 2012. Nursing Times. 25 March 2016. Web.