Constipation is more than simply having fewer bowel movements. It includes experiencing at least two of the following symptoms<\/a>: <\/p>\n\n\n\n Constipation due to medication is not just uncomfortable. It can lead to more severe health issues,<\/a> some of which may surprise you, such as: <\/p>\n\n\n\n Medication-related constipation is one of the most common causes of secondary constipation. A large study reviewing medical records in Japan found that about 11% of cases of treated constipation<\/a> are medication\u2011related. <\/p>\n\n\n\n It is especially common among people taking opioid pain medication: about 22 to 81% <\/a>of people taking these drugs can experience constipation. <\/p>\n\n\n\n And for those on Glucagon-like peptide receptor agonists (GLP-1 RAs), studies on those who have diabetes or obesity have found that up to 37% struggle with <\/a>constipation<\/a>.<\/a> <\/p>\n\n\n\n Medications can decrease gut motility, increase water absorption from the colon, and disrupt nerve pathways, leading to dry, hard stools. <\/p>\n\n\n\n Several types of medications can lead to constipation: <\/p>\n\n\n\n Opioids are used for pain control. To a lesser extent, non-steroidal anti-inflammatory drugs such as ibuprofen can also be linked to constipation. <\/p>\n\n\n\n The narcotic effect of pain medication can also cause nerves in the gut to ‘sleep,’ which slows movement through the intestinal tract . This can lead to hard, dry stools which are difficult to pass. <\/p>\n\n\n\n These are a large class of medications found in many over-the-counter and prescription medications, such as antihistamines, bladder antispasmodics for urinary incontinence, and some anti-nausea medications. <\/p>\n\n\n\n Anticholinergic medications block the effects of acetylcholine, a chemical that helps muscles move. This leads to reduced gut motility and, therefore, constipation. <\/p>\n\n\n\n These medications include antidepressants, antipsychotics, which may be used in schizophrenia, and Parkinson\u2019s medications. <\/p>\n\n\n\n A lot of antidepressants that treat the nerve endings in the brain also affect nerve endings in the gut, again slowing movement and leading to constipation. <\/p>\n\n\n\n Calcium channel blockers relax smooth muscles in the gut and can cause constipation. <\/p>\n\n\n\n Even regular food\/dietary supplements or over-the-counter medications like iron and antacids are linked to constipation. They reduce intestinal transit time, resulting in harder, drier, and more difficult-to-pass stools. <\/p>\n\n\n\n GLP1 RAs are used to manage diabetes or support weight loss. <\/p>\n\n\n\n People taking these medications feel full, so they may decrease their fluid intake. GLP1 RAs also delay intestinal transit time and gastric emptying, reducing the overall speed of the digestive process. <\/p>\n\n\n\n Increase fibre gradually<\/strong> <\/p>\n\n\n\n The recommended total fibre intake<\/a> for adults aged 19 to 50 years is 38 grams\/day for men and 25 grams\/day for women. And for adults over 50 years old: 30 grams\/day for men and 21 grams\/day for women. <\/p>\n\n\n\n Add fibre slowly to your diet to allow your system to adjust and avoid gas and bloating. And increase fluid intake along with fibre, to help push it through your intestinal tract. <\/p>\n\n\n\n Fibre Sources<\/strong> <\/p>\n\n\n\n In terms of fibre type, aim for more soluble fibre when struggling with constipation. It draws water into the digestive tract, making stool softer and easier to pass. <\/p>\n\n\n\n Soluble is preferred to insoluble fibre, which increases bulk and may be counterproductive when taking drugs that slow intestinal transit time and pull water from the stool. <\/p>\n\n\n\n Soluble fibre-rich foods to <\/a>add<\/a>:<\/a> <\/p>\n\n\n\n When fibre may not help<\/strong> <\/p>\n\n\n\n And bulk-forming fibre supplements, such as psyllium, may not be the most appropriate choice for people taking medications that slow bowel movements (particularly opioids). They can sometimes worsen abdominal pain. <\/p>\n\n\n\n It\u2019s recommended to increase fibre intake with opioid use,<\/a> only if dietary fibre intake is inadequate. And even an increase to recommended levels of 25 (for women) to 38 grams (for men) a day is not always indicated, due to slow transit time with opioid use. <\/p>\n\n\n\n One review even suggests dietary fibre intake should not be higher than 20 grams<\/a> for those on opioids. <\/p>\n\n\n\n Staying well hydrated helps fibre work effectively and may reduce the risk of hard stools. <\/p>\n\n\n\n Here are the Canadian fluid guidelines<\/a>, which recommend drinking about 13 cups (~3 litres) of fluid per day for men and 9 cups (~2.1 litres) for women. <\/p>\n\n\n\n Another lifestyle strategy to prevent and treat constipation is routine and positioning. <\/p>\n\n\n\n Establish a daily routine<\/a>, and your body will get used to going to the toilet\/bathroom at the same time each day. Listen carefully to your body\u2019s signals and don\u2019t ignore the urge to go. <\/p>\n\n\n\n And consider using a footstool for a squatting position<\/a> to improve the angle, making it easier to pass a bowel movement. <\/p>\n\n\n\n If you are able, aim for at least 150 minutes of exercise per week.<\/a> Regular movement may help keep your bowels moving too. <\/p>\n\n\n\n If you’re still having trouble with constipation due to medication after making the above changes, you might need to talk to your doctor about a change or decrease in medication. <\/p>\n\n\n\n For example, reducing the GLP-1 dose <\/a>might be an option if it\u2019s causing constipation. But never stop or adjust a prescription medication without speaking with your healthcare provider. <\/p>\n\n\n\n And if iron supplements are an issue, you can consider switching to a different formulation.<\/a> Iron-induced constipation rates are high with traditional oral ferrous iron formulations such as ferrous sulphate, fumarate, or gluconate. <\/p>\n\n\n\n An alternative iron formulation may be more suitable, such as liposomal iron, which is released more slowly. Or microencapsulated iron, which requires a lower daily dose. <\/p>\n\n\n\n If the medication you\u2019re taking slows down transit or gut activity, an osmotic laxative, like Polyethylene glycol (PEG) or lactulose may help. They are often generally well tolerated and are available over the counter. <\/p>\n\n\n\n Osmotic laxatives work by drawing water into the bowel, softening stool and making it easier to pass. Lactulose is less suitable than Polyethylene glycol (PEG) in opiod-induced constipation, because while it is effective, it tends to cause more gas and bloating<\/a> than PEG. <\/p>\n\n\n\n PEG and lactulose are the only laxatives proven to work better than a placebo<\/a> in improving symptoms of opioid-induced constipation in research. <\/p>\n\n\n\n Stimulant laxatives (like Senna) can be used in addition to an osmotic laxative, two or three times weekly if osmotic laxatives aren\u2019t doing enough to help. Note that the usefulness of stimulant laxatives tends to decline with long-term use, and they can cause intestinal <\/a>pain. <\/p>\n\n\n\n Talk to your doctor about other prescription medications that are available to help with constipation, if OTC options don’t provide enough relief. For example, opioid antagonists like PAMORAs <\/a>(which stands for \u2018Peripherally acting -opioid receptor antagonist\u2019). <\/p>\n\n\n\n\n
Why does this matter? <\/strong><\/h2>\n\n\n\n
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How common is constipation from medication? <\/strong><\/h2>\n\n\n\n
Common Culprits <\/strong><\/h2>\n\n\n\n
1. Opioids & Pain Medication: <\/h3>\n\n\n\n
2. Anticholinergic Medications <\/h3>\n\n\n\n
3. Mental Health & Neurologic Medications: <\/h3>\n\n\n\n
4. Cardiovascular Medications <\/h3>\n\n\n\n
5. Supplements & Over-the-Counter Products <\/h3>\n\n\n\n
6. Glucagon-like peptide-1 receptor antagonists (GLP1 RA) <\/h3>\n\n\n\n
Strategies for Relief <\/strong><\/h2>\n\n\n\n
1. Fibre Intake:<\/strong> <\/h3>\n\n\n\n
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2. Hydration:<\/strong> <\/h3>\n\n\n\n
3. Routine and Positioning:<\/strong> <\/h3>\n\n\n\n
4. Physical Activity:<\/strong> <\/h3>\n\n\n\n
5. Medication Adjustments:<\/strong> <\/h3>\n\n\n\n
Over-the-Counter (OTC) Laxative Support <\/strong><\/h2>\n\n\n\n
Osmotic Laxatives <\/h3>\n\n\n\n
Stimulant Laxatives <\/h3>\n\n\n\n
Other Medication Options <\/h3>\n\n\n\n
When to Seek Medical Attention <\/h2>\n\n\n\n
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