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Author: Admin | 2025-04-28
To sixty percent of cases in non-cancer patients (for cancer patients this percentage is as high as 90%) receiving opioids. Opiate receptors in the gastrointestinal tract reduce motility and increase transit time, and the resulting increased absorption of fluid by the intestinal tract leads to hardening of stool and constipation.Functional vs. Opiate-Induced ConstipationFunctional constipation is broadly defined as the difficult passage of hard, dry stool, less frequently than the patient’s typical pattern of bowel movements. Characterizing a patient as constipated cannot be based solely on the number of bowel movements per day, or week, but rather as a function of their normal regularity. The Rome IV criteria for functional constipation includes at least two of following for a period of at least 3 months:Hard stools in at least 25 percent of defecationsStraining in at least 25 percent of defecationA sensation of incomplete evacuation in at least 25 percent of defecationsLess than 3 bowel movements per weekUse of manual measures (digital evacuation and/or support of the pelvic floor) to help move or remove the stools from the rectumPharmacotherapy and OICAll healthcare professionals prescribing opioids need to also consider prophylactic laxative therapy for constipation. Patients with predisposing factors (immobility, advanced age, poor diet, intra-abdominal pathology, neuropathy, concurrent use of other constipating drugs) are specifically indicated.While most laxatives can work to relieve constipation, bulk-forming laxatives like psyllium should be avoided.The most common regime for OIC is a stimulant (senna/bisacodyl) with or without a stool softener (docusate), or daily administration of an osmotic laxative (polyethylene glycol).Stimulating agents such as senna and bisacodyl are not typically recommended for longer-term use due to adverse side effects. Bisacodyl stimulants work by irritating the lining of the intestine wall causing muscle contractions that move along stool mass. This process occurs whether bisacodyl is taken orally or as a
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