Chronic pain affects more than one in five adults in America. Thankfully, prescription and over-the-counter medications can help ease the symptoms.
However, sometimes, the side effects can make things even more difficult. One of which is constipation.
Constipation from taking painkillers can be debilitating and is estimated to affect up to 86 percent of patients using these drugs.
You might be asking then, which pain reliever does not cause constipation?
Let’s talk more about pain-killer-related constipation, several pain medications that don’t cause constipation, and ways to manage pain-reliever-related constipation.
What Is Constipation?
Constipation is generally defined as having three or fewer bowel movements per week.
Its symptoms include straining, hard stools, mild pain in the abdomen, and feeling blocked up or that you haven’t completely emptied your bowels.
While occasional constipation is common and normal, some people experience moderate to severe constipation that can interfere with their daily life.
In some cases, constipation can cause bleeding, tears in the anus, painful hemorrhoids, or infection.
Causes
Many things can cause constipation, such as your lifestyle and diet. It can also be caused by certain medications, particularly pain medications or opioids.
Opioid medications include morphine, tapentadol, codeine, and tramadol.
These medicines can be very effective in relieving short-term pain or pain that lasts less than six months.
They can be used to effectively manage pain associated with cancer, injury, or surgery.
Unfortunately, 60 percent of people who take opioids experience constipation.
If you’ve been taking opioid medications for quite a while, you’re likely to have constipation.
These medications can make you constipated by slowing down the movement of stool through your intestines, causing your bowel more time to take the water out of your stool.
As a result, your stool gets hard, dry, and difficult to pass.
Painkillers aren’t the only culprit. Many other medications can cause constipation, such as:
- Iron supplements
- Tricyclic antidepressants
- Non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen
- Antihistamines
- Overactive bladder medications
- Blood pressure medications
Unfortunately, it’s challenging to address medication-related constipation.
Additionally, older adults are more vulnerable to the constipation side effect of pain medications than younger people due to an off-balance digestive system that is usually caused by natural aging or a medical condition.
Which Pain Reliever Does Not Cause Constipation?
Unfortunately, all opioid medications can cause constipation.
However, a few pain relievers have been found to cause less constipation, such as targinact, fentanyl, and methadone.
Targinact
Targinact is a combination medication containing two active ingredients: naloxone and oxycodone.
Naloxone is an opiate antagonist used to lessen constipation caused by oxycodone.
Targinact (Targin) treats severe pain in adults who require pain relief for 24 hours or several days.
However, it should only be used for patients whose other pain medications or treatments are ineffective or not tolerated.
According to studies, targin has superior gastrointestinal tolerability compared to other opioid medications.
It offers advantages over using strong painkillers plus laxatives where required.
Fentanyl
Fentanyl is a synthetic opioid developed for helping cancer patients deal with pain. It usually comes in the form of a slow-release patch.
Fentanyl is much stronger than most opioids, up to 50 to 100 times more than morphine, and is dangerous if misused.
Even a small amount can cause overdose and, in severe cases, death.
In terms of constipation risk, fentanyl is superior to other types of opioid medications, particularly oxycodone.
Scientific findings revealed that elderly patients prescribed fentanyl may have a significantly lower risk of developing constipation than those who take oxycodone.
Methadone
Methadone is a medication used for pain management and treating Opioid Use Disorder (OUD).
It is often prescribed to patients with moderate to severe pain lasting for 24 hours or more.
A retrospective study has found that patients taking methadone for pain relief required fewer doses of laxatives.
What Can You Do For Painkiller-Induced Constipation?
Just because constipation is a common side effect of painkillers doesn’t mean you have to live with it for the entire time you’re taking the opioid medications.
There are steps you can take to lessen the discomfort caused by constipation, namely:
1. Start With a Stool Softener
Your first step to battling constipation caused by opioid medications is using a stool softener like docusate or Colace.
It’s a mild (OTC) over-the-counter drug, meaning you can buy it without a prescription. Stool softeners absorb more water, making your stool easier to pass.
You also don’t need to wait until you start experiencing constipation to take the softener.
Unless otherwise directed by your physician, take this medication orally before bedtime with a full glass of water or juice.
2. Add in a Laxative
Some experts believe stool softeners work best when taken with an oral laxative. But what’s the difference between a stool softener and a laxative?
As mentioned, a stool softener works by wetting and softening the stool. Meanwhile, a laxative is a medicine that facilitates a bowel movement.
Laxatives come in many forms, and a stool softener is just one of them.
For chronic constipation, your doctor may advise you to take a stimulant laxative like Senna or Dulcolax.
Unlike stool softeners that take effect after 24 or 48 hours, stimulant laxatives can relieve you in just six to 12 hours.
That said, be mindful of the laxatives you intend to use because not all of them work well for painkiller-induced constipation.
Reminders When Using Laxatives
Do not take bulk-forming laxatives like Prodiem, Citrucel, Fibercon, Psyllium, or Metamucil. Aptly named, these bulk-forming medications increase stool bulk and stimulate movements that push stuff through the colon.
These laxative agents will not help with opioid-induced constipation. They can actually make things worse as they can cause severe abdominal pain.
The first laxative you should try is sennosides which are available in tablet or liquid form. It’s a mild form of laxative and works for most people.
Begin by taking two sennosides at bedtime and wait for 24 hours.
If after a day you have a bowel movement that is soft and comfortable to pass, you’re good.
However, if you are still constipated, you may need to increase your dosage to two sennosides at breakfast and two more at bedtime.
Additionally, you must stop taking laxatives if you have diarrhea until your bowel movement has normalized.
Likewise, stop taking the said med if you experience severe stomach cramps, and call your health care provider.
If you have a history of Irritable Bowel Syndrome (IBS), you may want to take an osmotic laxative instead, such as PEG.
However, it’s best to talk to your doctor to find the best option for you.
3. Drink More Water
Dehydration is one of the most common reasons many people get constipated, and taking pain relievers can worsen it.
Plus, getting the amount of fluids your body needs when dealing with pain can be difficult.
If you’re taking opioid medications for several days or more, strive to drink more water throughout the day.
Increasing your fluid intake can help relieve constipation by softening your stool and stimulating bowel movement.
Aim for two to three liters of water every day. Aside from water, certain fruit juices can aid against constipation, such as prune juice, lemon juice, and green smoothies.
4. Get Moving
Aside from taking laxatives and stool softeners, and hydrating more, it also helps to increase your physical activity.
Exercise usually lessens simple constipation by stimulating the nervous system and helping the nerves and muscles in the gut to work better.
Yet, when you’re in pain, who feels like exercising?
While you may find certain exercises challenging with your pain, some gentle, low-impact options can help facilitate healthy bowel movements, such as:
- Water Exercise
Swimming and water aerobics are great options to keep your body moving.
Plus, the soothing effect of water, especially warm water, may help ease your pain.
- Walking
Research shows that lack of physical activity increases the risk of constipation two-fold.
Thus, if you’re taking pain medications, not exercising can put you at an even greater risk of constipation.
Fortunately, even small steps like climbing the stairs instead of taking the elevator or parking your car away from the office or store can help.
- Yoga and Stretching
These low-impact exercises can make the bowels more pliable and help your digestive system work the way it should.
What’s more, they have a relaxing and meditative effect on your body which is great for managing chronic pain.
5. Watch Your Diet
Eating more fiber can greatly help with opioid-induced constipation as well.
One kind of fiber that’s specifically beneficial for this condition is “soluble fiber” which you can get from oatmeal, bran cereal, barley, and flax.
You can also increase your fiber intake by eating healthy food items like fruits, vegetables, and whole grains.
Nuts and seeds are also a convenient way to add more fiber to your diet. Add them to your hot or cold cereal, salads, veggie stir-fries, smoothies, and baked goods like bread or muffins.
Dealing With Medicine-Induced Constipation
Which pain reliever does not cause constipation? Unfortunately, all painkillers can cause constipation, but a few medications are associated with lesser risk.
The good thing is that there are some steps you can take to lessen the discomfort.
However, if your constipation persists even after taking the tips and advice listed above, it’s best to consult your healthcare provider.
A few medications are available for opioid-induced constipation, including methylnaltrexone and naloxegol, but they require a doctor’s prescription.
To sum up, here are the key takeaways to keep in mind:
- Many things can contribute to constipation, such as your diet, medications, and supplements you may be taking.
- Most types of painkillers or opioid medications have the potential to cause constipation.
- If you think you’re experiencing constipation from taking a pain reliever, it’s best to talk to your doctor or pharmacist for specific advice.
- You can take specific medications along with pain relievers to offset the latter’s side effects.