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How to Avoid Opioid Induced Constipation (OIC)

Opioid Induced Constipation

Constipation is defined as infrequent bowel movements or the passage of hard stools, causing discomfort.  In patients taking opioids for pain, Opioid Induced Constipation is a frequent occurrence.  While there are many effective medications on the market for treating Opioid Induced Constipation, you may want to try some of these helpful recipies first.
How to prevent constipation:
Below is a list of ways to avoid constipation.  Start with #1 and move down the numerical steps until bowel movements are soft and regular.
1. Drink 8-10 glasses of fluid per day, including fruit juices. Eat a high fiber diet including raw fruits and vegetables, dried fruits, and whole grains. Fiber is important. Cereals such as Quaker Oatmeal Squares are high in fiber. In addition, try the juice recipe below:
Juice recipe:
1 oz prune juice
1 oz apricot nectar
1 oz water
1 oz Karo®  syrup
Mix in a pitcher and drink 4 oz. every day. Adjust the amount to softness and frequency of stool.
2. Psyllium: a bulk laxative made from the husks of seeds.  It can be purchased over the counter; better known as Metamucil® . Take as directed once or twice a day, mixed with water. Psyllium can also lower cholesterol.
3. Stool Softener: (Dioctyl sodium sulfosuccinate, DSS), Ducosate sodium 250 mg or 1 capsule orally; or Colace®  100 mg by mouth 2 times per day may be purchased without a prescription. Remember to keep up your fluids with juices and water as in Step 1.
4. Take a laxative/stimulant  if you have no bowel movement for 3 days despite following steps 1 through 3 above. 
Laxatives increase bowel activity so that stool moves down and out. Take Senokot®  2 tablets at night. This may be increased to 2 tablets 3 times per day as needed (6 tablets per day maximum).
5. If Senokot®  2 to 6 tabs per day do not work, add a Dulcolax®  Suppository in the rectum the next morning.
Caution : These stronger laxatives can cause cramping.
6. If Dulcolax®  doesn’t result in a bowel movement; take Milk of Magnesia (MOM) 15-30 mls or Lactulose 30 mls (2 tsp). If you have no bowel movement within 3 hours, take another Dulcolax®  suppository. If no results by evening, use a Fleet®  enema.
7. Magnesium Citrate: this can be found over the counter at any pharmacy.  Follow the directions on the bottle.  
8. If the above guideline does not work, or you are having increasing pain or cramping in your abdomen, call your physician.

Dr. Corey Hunter is a nationally recognized interventional pain physician and the founder of Ainsworth Insitute. His publications have appeared in textbooks on treating pain and he is a regular contributor in leading pain management journals.