If you're recovering from back surgery or taking painkillers for back pain, constipation may be more than an occasional irritation.
What's to blame? If you’ve just had surgery, the effects of anesthesia could play a role. Limited mobility, stress, and changes in your diet can also be factors.
Another common culprit is the medications often used to treat back pain. As they relieve pain, they also put the brakes on the digestive process. Painkillers, also called opioids or narcotics, are well known for causing constipation and other gastrointestinal side effects, including nausea and bloating. Some antidepressants, cold medicines, and many sedatives can have a similar impact.
7 strategies to get going when constipation strikes
The good news is that there are steps you can take to ease the discomfort from this common problem. Try these seven constipation-relieving tactics:
- Adjust your diet. Eating a nutritious, balanced diet that emphasizes whole grains and fresh fruits and veggies is a good place to start. Boost your level of fiber, but start slowly to avoid bloating. Soluble fiber—the kind in barley, flax, and oats as well as in some fruits and vegetables—is usually the easiest kind to tolerate. Steer clear of fatty or fried foods.
- Consider a different opioid. If you're taking an opioid, switching to another one may help. One study found that people with low back or osteoarthritis pain who took tapentadol (Nucynta) had fewer problems with constipation than those taking oxycodone immediate release (OxyContin, Percocet)1
- Ask about alternatives to opioids. The side effects of opioids prompt many people with back pain to stop using them altogether. If you've been taking them for a while and want to quit, ask your doctor how to stop gradually so you can avoid painful or uncomfortable withdrawal symptoms. Non-opioid pain medications may be a good replacement for pain relief. These medications could include acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil, and others) or naproxen (Aleve, Naprosyn). Some people reduce—but don't eliminate—opioids by supplementing them with non-opioid pain medication.
- Pay attention to your body. If you feel the urge, get to the bathroom right away. Build in some extra time in your daily schedule so you can take your time in the bathroom when needed.
- Drink up. Dehydration can make constipation worse. Water is a good choice, and prune juice and apple cider (rather than apple juice) are natural laxatives. While drinks without caffeine are generally preferred, some people find that a small amount of a cola drink has a laxative effect.
- Exercise more if you can. Moving around as much as possible—if your doctor gives you the OK—helps your body function better. If a long exercise session isn't an option, try to exercise gently for a few minutes at a time throughout the day.
- Try a stool softener or laxative. If you're taking an opioid following surgery, your doctor may suggest you take a nonprescription laxative or stool softener as a preventive measure. Bulk fiber laxatives (Citrucel, FiberCon, and Metamucil) may take several hours to take effect. Stool softeners (Colace, Dialose, DSS, and Surfak) mix fluid with stool to soften it, making it easier to pass. Stool softeners may take up to three days to show results. Stimulant laxatives (Dulcolax, Ex-Lax, and Milk of Magnesia) trigger contractions in the bowels, and work within a few hours. Suppositories (Dulcolax) usually show results more quickly.
If these efforts don't offer relief, talk with your doctor about prescription medications or biofeedback therapy to help you get back in control.
- Kwong WJ, Hammond G, Upmalis D et al. Bowel function after tapentadol and oxycodone immediate release (IR) treatment in patients with low back or osteoarthritis pain. Clin J Pain 2013;29:664–672.