Laxatives And Pain Relievers: A Safe Combination? (2024)

Constipation is a common side effect of taking painkillers, especially opioids. It can be a serious problem, but there are treatments that can help. Doctors often recommend laxatives and stool softeners to help keep bowel movements regular. Laxatives stimulate the muscles in the intestines, helping stool to pass more quickly, while stool softeners make waste softer and easier to pass. There are also over-the-counter options, such as polyethylene glycol (PEG) and docusate sodium (Colace), which can be taken orally or as a suppository. Lifestyle changes, such as drinking more water, eating more fibre, and exercising, can also help prevent and relieve constipation.

Opioid painkillers and constipation

Opioid painkillers are a type of prescription medication that can effectively block pain signals by attaching to receptors in the nervous system. However, they can also cause constipation, known as opioid-induced constipation (OIC). OIC is a common side effect, affecting 40-60% of patients without cancer who take opioids. It can present immediately or gradually during opioid therapy.

The main symptoms of opioid-induced constipation are hard and dry stools, decreased bowel movements (less than three per week), and straining during defecation. Constipation can lead to further complications such as abdominal pain, bloating, nausea, and even intestinal blockage if left untreated.

To prevent OIC, laxatives must be started simultaneously with opioid therapy. Bulk-forming laxatives, such as psyllium, should be avoided as they can worsen abdominal pain and contribute to bowel obstruction. Recommended laxatives for OIC include:

• Stimulants: biscacodyl (Ducodyl, Dulcolax) and senna-sennosides (Senokot)
• Osmotics: oral magnesium hydroxide (Phillips Milk of Magnesia) and polyethylene glycol (MiraLAX)
• Stool softeners: docusate (Colace) and docusate calcium (Surfak)

In addition to laxatives, lifestyle changes are crucial in managing OIC. These include:

• Increasing dietary fiber: Consume 25-30 grams of fiber per day from fruits, vegetables, whole grains, and fiber supplements like Metamucil or Citrucel.
• Drinking plenty of fluids: Aim for 8-10 glasses of fluid per day to prevent dehydration, which can worsen constipation.
• Regular exercise: Engage in 30 minutes of physical activity most days of the week to stimulate intestinal contractions and promote bowel activity.

If lifestyle changes and over-the-counter laxatives do not provide relief, prescription medications specifically for OIC are available and should be discussed with a doctor. These medications include:

• Naloxegol (Movantik)
• Methylnaltrexone (Relistor)
• Lubiprostone (Amitiza)
• Naldemedine (Symproic)

It is important to consult a healthcare professional before taking any medications or making significant dietary or lifestyle changes. They can provide guidance and recommend the most suitable treatment options for managing opioid-induced constipation.

Over-the-counter pain relievers and constipation

Constipation is a common side effect of taking pain medications. Non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioid painkillers can all lead to constipation. Opioids are the most likely to cause constipation, with 40-80% of long-term opioid users experiencing this issue.

Over-the-counter (OTC) pain relievers such as ibuprofen, aspirin, and acetaminophen are often chosen by patients because they are non-habit forming and less likely to cause constipation than opioid medications. However, constipation is still a possible side effect of these medications, especially when taken in higher-than-recommended doses.

Preventing Constipation

To prevent constipation when taking OTC pain relievers, patients should be advised to:

• Consume fiber-rich foods such as apples, bananas, beans, and whole grains
• Stay hydrated, especially with water and non-diuretics
• Increase physical activity
• Develop a routine by setting aside the same time each day for a bowel movement
• Limit intake of foods and medications that cause or worsen constipation, such as processed grains, dairy products, and fried foods

Treating Constipation

Laxatives can be used to treat constipation caused by OTC pain relievers. Doctors often prescribe laxatives alongside opioids to prevent constipation. Bulk-forming laxatives like psyllium should be avoided, as they can worsen constipation if not taken with enough fluids. Stimulant laxatives, such as senna and bisacodyl, are commonly used to treat constipation, but they are not recommended for long-term use due to potential side effects. Osmotic laxatives, such as polyethylene glycol, are another option that works by drawing water into the intestines to allow for easier stool passage.

Laxatives and their types

Laxatives are a type of medicine used to treat constipation. They are often used when lifestyle changes, such as increasing fibre intake, drinking more fluids, and exercising, have not helped. Laxatives are available over the counter in pharmacies and supermarkets, or on prescription from a doctor. They should be taken as directed to prevent side effects such as bloating, gas, and stomach cramps.

There are several types of laxatives, including:

• Bulk-forming laxatives: These increase the weight of the stool, stimulating the bowel. They typically take 2-3 days to work. Examples include Fybogel (ispaghula husk), psyllium (Metamucil), and methylcellulose (Citrucel).
• Osmotic laxatives: Osmotic laxatives draw water from the body into the bowel, softening the stool and making it easier to pass. They also usually take 2-3 days to work. Examples include lactulose (Duphalac, Lactugal), macrogol (Movicol, Laxido), and magnesium hydroxide solution (Dulcolax, Ex-Lax, Phillips' Milk of Magnesia).
• Stool softener laxatives: Also known as emollient laxatives, these increase the water and fat absorbed by the stool, making it softer. An example is docusate (Colace).
• Lubricant laxatives: Lubricant laxatives coat the colon, preventing water absorption from the stool and making it slippery and easier to pass. An example is mineral oil.
• Stimulant laxatives: These activate the nerves that control the muscles in the colon, forcing it to move the stool along. Stimulant laxatives include bisacodyl (Dulcolax) and senna (Fletcher's Laxative).

It is important to note that laxatives are not suitable for everyone and should be used with caution. They are not usually recommended for children or people with certain health conditions. Additionally, they should not be taken for longer than one week without consulting a healthcare professional.

Preventing constipation

Constipation is a common issue, affecting up to one in five people. It is characterised by fewer than three bowel movements per week, straining during bowel movements, hard and dry stools, and a feeling of incomplete emptying. This condition can be easily managed and even prevented with some simple lifestyle changes.

To prevent constipation, it is important to maintain healthy gut function. This can be achieved by making sure you are consuming enough dietary fibre, which is a type of carbohydrate that encourages digestion. Fibre-rich foods include fruits, vegetables, whole grains, nuts, and seeds. Women should aim for about 25 grams of fibre per day, while men should aim for 30 grams. It is recommended to introduce fibre into your diet gradually, starting with an apple or an orange every two days, and including more whole grain products.

In addition to increasing fibre intake, staying properly hydrated is crucial for preventing constipation. Aim to drink about two litres of liquids per day, mostly water. Warm fluids in the morning, such as coffee or tea, can help stimulate digestion. Physical activity also plays a role in promoting bowel movements, so getting regular exercise is recommended.

Making these simple dietary and lifestyle changes can help prevent constipation and improve your overall gut health. However, if constipation persists or becomes chronic, it is important to consult a healthcare professional for further guidance and treatment options.

Lifestyle changes to prevent constipation

Constipation is not only physically uncomfortable but can also be emotionally upsetting. The good news is that it can be resolved with some simple dietary and lifestyle changes. Here are some lifestyle changes you can adopt to prevent constipation:

Increase your fibre intake

Eating enough fibre is essential for preventing constipation. Fibre-rich foods include fruits, vegetables, whole grains, legumes, nuts, and seeds. Aim for 20-35 grams of fibre per day for adults, with specific recommendations of 25 grams per day for women and 38 grams for men under 50. Whole grains, such as whole wheat bread and pasta, oatmeal, and bran flake cereals, are excellent sources of fibre. Legumes, such as lentils, black beans, and chickpeas, are also fibre-rich options. When it comes to fruits, opt for berries, apples with the skin on, oranges, and pears. Vegetables like carrots, broccoli, green peas, and collard greens are also good choices. Additionally, nuts such as almonds, peanuts, and pecans can boost your fibre intake.

Stay hydrated

Drinking plenty of water and other fluids can help soften your stool and make it easier to pass. Aim for at least eight glasses of water per day, and avoid caffeine as it can be dehydrating. Naturally sweetened fruit and vegetable juices, as well as clear soups, can also contribute to your fluid intake.

Get regular exercise

Regular exercise helps keep your digestive tract moving and can prevent constipation. Try to get at least 150 minutes of moderate activity every week. Even a 10-20 minute walk after meals can be beneficial.

Listen to your body

When you feel the urge to have a bowel movement, don't ignore it. Holding it in can contribute to constipation. Establish a regular bowel routine by aiming to go at the same time every day, preferably 20-30 minutes after a meal when your intestines are stimulated to push food and waste through.

Manage stress

Stress can slow down the movement of food through your bowel, so finding ways to relax can help prevent constipation. Try meditation, deep breathing, or relaxation techniques such as mental imagery.

Be mindful of medication use

Certain medications, such as pain relievers (including opioids), antidepressants, and drugs for Parkinson's disease, can cause constipation. If you are taking any of these medications, consult with your doctor or healthcare provider to discuss alternative options or additional lifestyle changes that may be necessary.

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