Opioid Painkiller Users Experience 2 Weeks of Constipation; Doctors Urge Early Discussion of Alternative Therapies
Half of patients taking opioid painkillers experience constipation, with some cases involving two weeks of inability to defecate and severe abdominal pain. A nurse from Tri-Service General Hospital reported a case where an anal cancer patient's quality of life significantly deteriorated due to opioid-induced constipation (OIC), which improved after switching to peripherally acting μ-opioid receptor antagonists (PAMORAs). The president of the Taiwan Academy of Hospice and Palliative Medicine pointed out that OIC can lead to increased depression and low self-esteem, recommending early use of PAMORAs. It was also revealed that patients often find it difficult to discuss this issue with their doctors.
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- 📰 Published: April 13, 2026 at 17:16
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TAIPEI (CNA) – Half of clinical patients taking opioid painkillers experience constipation, and some individuals have been unable to defecate for up to two weeks due to severe anal wound pain, experiencing abdominal pain so severe they cannot eat. Doctors urge early discussion of medication changes to regain quality of life.
Hung Yu-chun, a nurse at the Tri-Service General Hospital's Hospice Ward, mentioned at a press conference today that she once encountered a single male in his 50s who, suffering from stage 4 anal cancer with severe fungating wounds in the perineum and anus, endured intense pain for a long time. He had to rely on opioid painkillers to control his condition but fell into another unspeakable torment: severe opioid-induced constipation (OIC).
Due to the excruciating pain from his anal wound, this patient could not manually defecate and could only rely on laxatives, but with limited effect. He was unable to defecate smoothly for up to two weeks, suffering from persistent abdominal distension and pain, which even affected his eating, ultimately leading to malnutrition and anemia. He was later hospitalized due to a fall and fracture. After evaluation by the medical team, he was switched to peripherally acting μ-opioid receptor antagonists (PAMORAs) for treatment.
Without affecting the pain relief, his bowel function improved, and he successfully passed soft stools the next day. His abdominal distension and discomfort significantly alleviated, and his overall quality of life improved markedly. He has now been discharged and continues to take the medication.
Hung Yu-chun pointed out that clinically, about 50% of patients using opioid painkillers experience OIC due to the drug's effect of slowing down gastrointestinal motility.
When patients using opioid painkillers develop OIC, they not only experience difficulty in defecation and hard stools but may also need to strain or rely on manual assistance for defecation. These processes not only bring physical discomfort but also cause patients to suffer psychologically from humiliation and helplessness. Hung Yu-chun called on clinicians to seriously address the physical and psychological impact of OIC on patients and to discuss appropriate treatment strategies with doctors as early as possible to increase bowel movement frequency and improve quality of life.
Cheng Shao-yi, president of the Taiwan Academy of Hospice and Palliative Medicine and director of the Family Medicine Department at National Taiwan University Hospital, said that in addition to cancer, many patients may need pain and OIC treatment, such as patients with end-stage heart disease, end-stage kidney disease, dementia patients, or half of patients in intensive care units. A questionnaire survey of 489 patients found that OIC can indeed lead to increased depression, low self-esteem, and irritability.
The survey showed that to relieve constipation symptoms, 30% of patients "missed doses" of opioid drugs to avoid OIC symptoms. Cheng Shao-yi pointed out that this means OIC may affect opioid drug adherence. Although many patients considered adjusting their opioid prescriptions, nearly 40% of patients said it was difficult to discuss with their doctors, and more than 10% worried that their painkiller dosage would be adjusted.
Cheng Shao-yi urged that the effectiveness of OIC treatment be evaluated as early as possible between doctors and patients, especially in the first week after starting treatment; she suggested that early use of PAMORAs can achieve higher benefits. Taking the use of PAMORAs in the United States over four years as an example, the number of beneficiaries increased from 4,221 to 72,592. (Editor: Chen Chieh-ling) 1150413
Hung Yu-chun, a nurse at the Tri-Service General Hospital's Hospice Ward, mentioned at a press conference today that she once encountered a single male in his 50s who, suffering from stage 4 anal cancer with severe fungating wounds in the perineum and anus, endured intense pain for a long time. He had to rely on opioid painkillers to control his condition but fell into another unspeakable torment: severe opioid-induced constipation (OIC).
Due to the excruciating pain from his anal wound, this patient could not manually defecate and could only rely on laxatives, but with limited effect. He was unable to defecate smoothly for up to two weeks, suffering from persistent abdominal distension and pain, which even affected his eating, ultimately leading to malnutrition and anemia. He was later hospitalized due to a fall and fracture. After evaluation by the medical team, he was switched to peripherally acting μ-opioid receptor antagonists (PAMORAs) for treatment.
Without affecting the pain relief, his bowel function improved, and he successfully passed soft stools the next day. His abdominal distension and discomfort significantly alleviated, and his overall quality of life improved markedly. He has now been discharged and continues to take the medication.
Hung Yu-chun pointed out that clinically, about 50% of patients using opioid painkillers experience OIC due to the drug's effect of slowing down gastrointestinal motility.
When patients using opioid painkillers develop OIC, they not only experience difficulty in defecation and hard stools but may also need to strain or rely on manual assistance for defecation. These processes not only bring physical discomfort but also cause patients to suffer psychologically from humiliation and helplessness. Hung Yu-chun called on clinicians to seriously address the physical and psychological impact of OIC on patients and to discuss appropriate treatment strategies with doctors as early as possible to increase bowel movement frequency and improve quality of life.
Cheng Shao-yi, president of the Taiwan Academy of Hospice and Palliative Medicine and director of the Family Medicine Department at National Taiwan University Hospital, said that in addition to cancer, many patients may need pain and OIC treatment, such as patients with end-stage heart disease, end-stage kidney disease, dementia patients, or half of patients in intensive care units. A questionnaire survey of 489 patients found that OIC can indeed lead to increased depression, low self-esteem, and irritability.
The survey showed that to relieve constipation symptoms, 30% of patients "missed doses" of opioid drugs to avoid OIC symptoms. Cheng Shao-yi pointed out that this means OIC may affect opioid drug adherence. Although many patients considered adjusting their opioid prescriptions, nearly 40% of patients said it was difficult to discuss with their doctors, and more than 10% worried that their painkiller dosage would be adjusted.
Cheng Shao-yi urged that the effectiveness of OIC treatment be evaluated as early as possible between doctors and patients, especially in the first week after starting treatment; she suggested that early use of PAMORAs can achieve higher benefits. Taking the use of PAMORAs in the United States over four years as an example, the number of beneficiaries increased from 4,221 to 72,592. (Editor: Chen Chieh-ling) 1150413