Methylnatrexone binds to mu-receptors in the gut but does not cross the blood-brain barrier, so the constipating effects of the opioid are reduced without affecting pain control.Īs you can see, water in the colon is vital for successful elimination. Methylnatrexone is indicated for opioid-induced constipation when laxative therapy has been unsuccessful. Two medications are approved in the United States for constipation caused by irritable bowel syndrome and idiopathic constipation: linaclotide and lubiprostone.
Saline laxatives (e.g., magnesium citrate) increase motility through osmosis of water into the colon.Stimulant laxatives (e.g., bisacodyl, senna) also promote water secretion into the colon and increase intestinal motility.Osmotic agents (e.g., polyethylene glycol 3350) stimulate peristalsis by promoting secretion of water into the colon wall.Fiber/bulk-forming agents (e.g., psyllium fiber, methylcellulose) hold water in the stool making it heavier and easier to move down the system.Stool softeners (e.g., docusate) work by drawing water into the stool to help reduce bowel wall friction and the need for straining.Unwanted side effects such as cramping, diarrhea, bloating, and gas can happen prior to constipation relief.
Onset of action for the listed medications is 12–72 hours. A good place to start is with what patients have previously found helpful. Lifestyle modifications typically take time to work but, combined with a therapeutic regimen, they can offer quick and lasting improvement. Bulk laxatives may not be the preferred treatment for less-mobile patients, and magnesium-containing laxatives could be detrimental if electrolyte imbalances are already a problem. Once you have asked the right questions, look at patients' current health and mobility status. Several disease states and metabolic problems can also cause constipation, so the more you know about the underlying factors, the more helpful your recommendations will be. Opioid-induced constipation is sometimes treated differently than other types of constipation. If you clicked only for the recipe, scroll to the bottom (pun intended) of this post.įirst, determine the most likely cause of constipation.
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Oncology nurses need to know how to advise patients when they bring up this somewhat uncomfortable subject. Pain medications, like morphine, hydromorphone, and hydrocodone, slow down the movement of stool through the bowel, resulting in opioid-induced constipation. Lack of mobility, dehydration, and tumors blocking or pressing against the bowel or nerves can all lead to constipation. Infrequent bowel movements (less than three times per week), hard stools, straining during evacuation, or a feeling of incomplete emptying are all signs of constipation. Constipation is no fun for anyone, but for patients with cancer this all-too-common side effect is especially troublesome.
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