Jahangeer Ganaie
Srinagar, Dec 5: With an increasing number of patients across Jammu and Kashmir using opioid-based painkillers for chronic pain, post-surgery recovery and cancer treatment, doctors say opioid-induced constipation (OIC) is becoming one of the most common yet least discussed side effects.
Health experts said that OIC affects a large proportion of patients on long-term opioid therapy and often leads to abdominal discomfort, bloating, reduced appetite and, in severe cases, dependency on laxatives.
They explain that OIC occurs when opioids — medicines prescribed to manage moderate to severe pain — slow down the movement of the intestines. These drugs act on the same receptors in the gut as in the brain, causing the bowel muscles to contract less effectively and reducing fluid secretion into the intestines.
“This results in stools becoming hard, dry and difficult to pass. Many patients feel embarrassed to talk about it, so the problem worsens,” said a senior gastroenterologist at GMC Srinagar.
Doctors explain that several mechanisms contribute to opioid-induced constipation (OIC). One of these is slowed gut motility, as opioids reduce the natural wave-like movements of the intestines, hindering the passage of stool. They said the colon absorbs more water, which makes the stool harder and more difficult to pass.
Opioids also cause tightening of the anal sphincter muscles, resulting in pain and difficulty during bowel movements. They dull the reflexes responsible for triggering the urge to defecate, further contributing to constipation, according to doctors.
While constipation may sound minor, doctors warn that untreated OIC can lead to several complications, such as severe abdominal pain and distension, haemorrhoids or fissures due to straining, nausea, vomiting and loss of appetite, impaction of stool requiring medical intervention and poor adherence to pain treatment because patients fear constipation more than the pain itself
“OIC significantly affects quality of life. Some patients even start avoiding their pain medicines, which is risky and leads to uncontrolled pain,” said Dr Sameer Ahmad, a physician at Shopian.
He said the condition is manageable through timely measures. These include increasing fibre intake by consuming fruits, vegetables, whole grains, and psyllium husk, which help regulate bowel movements.
Staying adequately hydrated by drinking sufficient water also softens the stool, Dr Sameer said, adding that maintaining physical activity through walking and light exercise can improve gut mobility.
“When necessary, laxatives such as stool softeners, osmotic laxatives, or stimulant laxatives may be prescribed by doctors to provide relief,” he said.
It is important to avoid self-medication and the use of special medications for OIC without medical guidance, as in severe cases, physicians may prescribe targeted drugs like PAMORAs (Peripherally Acting Mu-Opioid Receptor Antagonists), Dr Ahmad said, adding that these medications specifically block the effects of opioids in the gut without compromising pain relief.
Doctors emphasise that constipation linked to opioids is not just a discomfort but a clinically significant condition that must be addressed early.
“Patients should never discontinue opioids on their own. Instead, they must inform their doctor so that the treatment can be adjusted,” they said.
