Opioid-induced constipation

Recent initiation of an opioid or dose adjustment

New or worsening constipation

Fecal impaction may be present

Physical examination typically normal

Clinical diagnosis

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

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.

Medical therapy

• Laxative therapy

  • Osmotic laxative

  • and/or stimulant laxative

• Options for laxative-refractory OIC:

  • Peripherally acting μ-opioid receptor antagonists