List clinical features.
Recent initiation of an opioid or dose adjustment
New or worsening constipation
Fecal impaction may be present
Physical examination typically normal
Describe the diagnostics.
Rome IV diagnostic criteria for OIC
Recent initiation of opioid treatment or a dose increase
AND ≥ 2 of the characteristic clinical features of functional constipation:
Passage of spontaneous bowel movement < 3 times/week
Passage of hard or lumpy stool (more than 25% of defecations)
Sensation of anorectal obstruction/blockage (more than 25% of defecations)
Manual aid to evacuate stool necessary (more than 25% of defecations)
Straining during attempts to defecate (more than 25% of defecations)
Sensation of incomplete evacuation (more than 25% of defecations)
Loose stools are rarely present without the use of laxatives
Consider x-ray of the abdomen to rule out fecal impaction
Describe the treatment.
Similar to the treatment of primary constipation; see “Treatment.”
Identify and treat any underlying organic cause.
Lifestyle and dietary modification
Evaluate the need for opiate therapy and discontinue/reduce dose if appropriate.
and/or stimulant laxative
Options for laxative-refractory OIC:
Peripherally acting μ-opioid receptor antagonists