Why Suboxone Causes Constipation and Here's What Can Help in 2023!
If you’ve started taking Suboxone for opioid use disorder and feel backed up, you’re not alone. Constipation is one of the most common side effects of Suboxone yet least discussed side effect of this life-saving medication. The problem can become agonizing, yet patients often suffer in silence, unaware that relief is possible. In this blog, we’ll explore the causes behind Suboxone and constipation, signs to watch for, and most importantly, the lifestyle changes and treatment options available to help get things moving smoothly again. People battling addiction deserve compassionate care and minimal issues with constipation and stomach pain. You shouldn’t have to choose between being uncomfortable and recovery.
What Exactly is Suboxone and Why is it Used for Opioid Addiction?
Suboxone is more than just a medication. For many, it represents the lifeline that makes overcoming opioid addiction possible. The science behind this treatment is fascinating yet often misunderstood.
Suboxone contains buprenorphine and naloxone. Buprenorphine, a partial opioid that interacts with opioid receptors to fend off opioid withdrawal symptoms and cravings without significant “highs”. And naloxone, was added to deter misuse. Together, they help normalize brain opioid signaling. When taken properly, the naloxone has minimal effects.
Of course, biology is complex. But essentially, Suboxone stabilizes opioid receptors in the brain just enough to ease recovery’s torment, while blocking other opioids’ dangerous effects. A nuanced solution for a nuanced problem.
Why Suboxone Causes Constipation in So Many People
If you’ve started taking Suboxone, you’ve likely noticed it makes you pretty constipated. And unfortunately, you’re not alone at all. Studies show constipation affects 40% to 65% of people using Suboxone. It’s by far the most common side effect.
But what’s actually happening in the body to cause this? There are two main reasons why constipation is a common side effect:
1) Buprenorphine activates opioid receptors in your GI tract - Like other opioid drugs, buprenorphine binds to opioid receptors located throughout your gastrointestinal (GI) tract. This has the effect of slowing down peristalsis. Peristalsis is the wave-like muscle contractions your intestines make to push food through your digestive system. With the buprenorphine making these muscles more sluggish, your stool moves much more slowly through your intestines. And the end result is...you guessed it...constipation.
2) Buprenorphine increases anal sphincter tone - In addition to slowing things down in your intestines, opioids also cause the muscles around your anus (your anal sphincter) to tighten up. With this tightening, it’s tougher for stool to actually exit the body. Just another way opioids like the buprenorphine in Suboxone bind you up.
So in summary, the buprenorphine, like short-acting opioids and long-acting opioids, has a dual effect of slowing down the movement of stool through your intestines while also making the exit tighter. This one-two punch on your digestive system is why so many people struggle with constipation when using Suboxone.
Signs Your Constipation May Be From Suboxone
If you’ve started taking Suboxone and feel “stopped up”, how can you tell if it’s definitely from the medication rather than other factors?
Signs your constipation may be linked to Suboxone or other opioids include:
Having fewer than 3 bowel movements per week (less poops than your “normal”)
Dealing with hard, dry, or lumpy stool when you do finally go
Straining more to get anything out
Feeling you can’t fully empty your bowels after going
Experiencing bloating, abdominal pain, nausea
Keep in mind we all have slightly different “normal” bathroom habits. You might just poop every other day and that’s your regular pattern. The key with opioid-induced constipation is it’s marked by a change from your usual pooping routines. If you find yourself straining way more, stools are rock hard, or you just aren’t going as often, that points to the Suboxone being the culprit.
Why It’s Important to Find Relief When Constipated from Suboxone
At first glance, constipation might seem like a minor nuisance. But there are some good reasons you’ll want to get relief if it’s affecting your everyday life:
Major dip in your quality of life - When constipation gets bad, it can really take a toll on your day-to-day comfort and functioning. You may feel bloated and sluggish. And it can definitely make it hard to concentrate at school or work, take care of family, exercise, or just enjoy your free time.
Risk of impaction or bowel obstruction - In really severe cases of chronic constipation that isn’t treated, you can actually develop a full impaction (blockage) in your intestines. This requires emergency medical treatment, so it’s definitely something you’ll want to avoid!
Reduced medication compliance - Studies show up to 1 in 3 people discontinue their opioid medications because constipation makes them feel so cruddy. So treating this side effect is really important to stay compliant with your Suboxone regimen and keep reducing opioid cravings.
The good news is there are lots of effective remedies for relieving constipation from Suboxone and other opioids. Let’s run through your options...
Lifestyle Tweaks and Home Remedies to Get Things Moving
Before turning to medications, there are several natural ways you can encourage more regular poops:
Guzzle enough fluids - Staying properly hydrated is key for keeping your poop soft and bowel movements regular. Aim to gulp down 8-10 glasses of water a day or other non-caffeinated fluids per day. Prune juice is also a natural mild laxative. How much water should you drink? Discuss with your doctor.
Eat more high-fiber foods - Fiber adds bulk to stool and acts like a sponge to pull in water and keep things soft. Load up on high-fiber fresh fruits and vegetables, whole grains, beans, lentils, nuts and seeds. Work up to 25-35 grams of fiber daily.
Exercise more - Physical activity helps speed up the passage of food and stool through your intestines. Shoot for at least 30 minutes a day of moderate exercise like walking. Check with your doctor first if mobility issues limit your movement.
Establish a bathroom routine - Going to poop at the same time daily helps train your body and mind to stay regular. So try to hit the can when you first wake up.
Consider probiotic supplements - Probiotics add healthy gut bacteria and can help reduce constipation. Yogurt, kefir, kimchi and other fermented foods also contain probiotics.
If your constipation is mild, lifestyle tweaks like these may get your bowels back on track. But when opioids like Suboxone are causing the backup, additional remedies are often needed.
Using Over-the-Counter Laxatives for Relief
When natural remedies aren’t quite doing the trick, adding an over-the-counter laxative into the mix may get you more regular. Some options to try:
Stool softeners (like docusate) - These lubricate and soften stools to make them easier to pass. Can also be used rectally for direct relief. This drug is a common first line treatment for opioid induced constipation.
Osmotic laxatives (like magnesium, polyethylene glycol) - they increase the absorption of fluids into your intestines to help hydrate and loosen stool.
Stimulant laxatives (like bisacodyl, senna) - These make the muscles in your intestines contract more to spur a bowel movement. Tend to work pretty quickly but can cause cramping.
Lubricant laxatives (like mineral oil) - Coat the stool and the end of the digestive tract for easier passage out of the body. These come in the form of an enema.
Talk with your pharmacist or doctor about which OTC laxative might be best for your body and symptoms. It often takes some trial and error. Start with lower doses and gradually increase strength as needed.
Prescription Medications That Target Opioid-Induced Constipation
For stubborn cases of Suboxone and constipation that don’t improve with OTC options, several prescription meds specifically help alleviate constipation:
Lubiprostone (brand name Amitiza) - Approved to treat opioid constipation. Works by causing more fluid secretion into the intestines to help soften stool.
Naloxegol (brand name Movantik) - Blocks opioid pain relief receptors specifically in the GI tract that cause constipation but doesn’t reduce systemic opioid pain relief effects.
Methylnaltrexone (brand name Relistor) - Similar to Movantik, blocks constipation-causing opioid receptors in the gut without affecting central opioid pain relief. Can be injection or tablets.
Alvimopan (brand name Entereg) - Related mechanism of action as Movantik and Relistor. Currently FDA approved only for short-term hospital use due to side effects with longer-term use.
These prescription medications can offer big relief when other options fail. But they are pricey and often need insurance approval in advance before being covered.
When to See Your Doctor About Symptoms of Opioid-Induced Constipation
Make an appointment with your healthcare provider if you experience constipation or any of the following:
Lifestyle adjustments and OTC laxatives aren’t helping after several weeks of trying
You aren’t having a bowel movement for 3 or more days in a row
You’re experiencing intense belly pain or discomfort along with constipation
You have nausea, vomiting, or other severe symptoms
With chronic constipation, it’s important to get properly diagnosed and treated. Your doctor can check for potential underlying causes and help get your bowels back on track.
In some cases, they may recommend temporarily stopping Suboxone or rotating to a different opioid medication to see if that causes less constipation for your body. But only make medication changes under medical supervision since abruptly stopping opioids can cause withdrawal.
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Key Takeaways on Suboxone, Opioids, and Constipation
To sum it all up, here are some of the key points to remember and to always discuss with your doctor first:
Suboxone is an important medication used to treat opioid addiction but it can cause side effects.
Most people taking suboxone experience moderate constipation.
Suboxone constipation is treatable - Don’t just accept it as normal!
Treating opioid-induced constipation can greatly help your quality of life, allow you to stay compliant with Suboxone treatment, and avoid complications like impactions.
Lifestyle changes, OTC laxatives, prescription medications, and working closely with your doctor can help identify an effective treatment relief from constipation problems!
The bottom line is you don’t have to put up with Suboxone or opioid constipation. With the right combo approach tailored to your body and symptoms, you can get back to more comfortable and regular bowel movements. Here’s to pooping better...and feeling better all around!
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.