Professor Anton Emmanuel
Professor in neuro-gastroenterology at University College London and consultant gastroenterologist at UCLH and the National Hospital for Neurology and Neurosurgery
Opioid medication — including codeine, tramadol and morphine, which can work well for pain relief but may cause debilitating constipation — can impact a patient’s quality of life. The advice is: don’t put up with constipation. Speak with your clinician to get help.
If you suffer from pain — such as pain related to an injury or cancer pain — you may be prescribed opioid medication for pain relief. Much has been written about the potentially addictive nature of these drugs when taken long-term.
Debilitating side effects of opioid
Opioids can have a range of less talked about, side effects — one of which is constipation. While it might sound trivial, opioid-induced constipation (OIC) can have a profound effect on a person’s quality of life, says Anton Emmanuel, Professor in Neuro-Gastroenterology at University College London and Consultant Gastroenterologist at UCLH and the National Hospital for Neurology and Neurosurgery.
It affects around half of all patients taking opioid medication. Sadly, some patients can feel that constipation is the price they must pay to manage their pain. But it shouldn’t and doesn’t have to be that way.
Opioid-induced constipation
is different because it affects
you every, single day.
How symptoms can impact quality of life
Of course, everyone has acute constipation occasionally, notes Prof Emmanuel. The urge to open your bowels reduces. You spend longer in the bathroom, strain on the toilet and don’t feel fully empty.
“Opioid-induced constipation is different because it affects you every, single day, so it’s not simply feeling ‘a bit bunged up’ now and then,” Prof Emmanuel explains. “Often, quality of life factors are worse. It can impair social, emotional and physical function. It can make people feel stigmatised, affect their mood and create a huge amount of personal turmoil. Another rare but unpleasant symptom of OIC is bowel incontinence, which causes real distress.”
In fact, says Prof Emmanuel, opioid induced constipation is the most common reason patients avoid and/or discontinue opioids.
Ways to relieve opioid-induced constipation
Thankfully, there are ways to relieve OIC symptoms, although that means talking more frankly about our bowels and, unfortunately, embarrassment can get in the way. “There is a cultural taboo around this subject,” agrees Prof Emmanuel. “People feel ashamed, but there comes a point where patients say: ‘I’ve got to do something. I can’t manage this burden any longer.’”
His advice is: don’t suffer in silence. Take action. “First of all, be preventative,” says Prof Emmanuel. “Try to drink at least a litre and a quarter of liquid a day (it doesn’t have to be water) and maintain your mobility. That can be difficult, depending what you are taking your pain relief for, but do what you can because your bowel is most likely to contract in the morning, so breakfast and a walk around the park is often the best trigger.”
Seek help from your pharmacist or doctor
Surprisingly, diet doesn’t have much of a part to play in OIC relief. Contrary to popular belief, cereal fibres such as bran almost certainly don’t help. “It can just make you more windy,” he says. “Although fibres from prunes and stewed fruit may help a little.”
One of Prof Emmanuel’s biggest tips is: listen to your body. “People who are constipated shouldn’t ignore the urge to go because it happens so infrequently. If they miss it, they may find the moment has gone.”
If you’re still experiencing symptoms after taking preventative measures, see your pharmacist. “Pharmacists are very well-informed about the type of laxatives to use,” says Prof Emmanuel. “However, OIC doesn’t always respond to laxatives, so it’s important to explore the options with your doctor and get your bowels functioning properly without affecting your pain management.”
MA-UK-Gastroenterology-05/25-00001 May 2025
