8 Counseling Points for Patients with Constipation

A Super Bowl 50 commercial may be encouraging patients to seek help for their constipation.

The black-and-white ad was funded by AstraZeneca and Daiichi Sankyo, which market naloxegol (Movantik) tablets that can help treat adults with chronic noncancer pain who have opioid-induced constipation (OIC).

“Opioids block pain signals but can also block activity in the bowel, which is why it may feel like your opioid pain medication is slowing your insides to a crawl,” the ad stated.

The commercial was aimed at raising OIC awareness, but critics argued that it normalized opioid use.

“Next year, how about fewer ads that fuel opioid addiction and more on access to treatment,” tweeted White House Chief of Staff Denis McDonough (@Denis44), on February 8, 2016.

Next year, how about fewer ads that fuel opioid addiction and more on access to treatment. #SB50 pic.twitter.com/k6rWa7tIw1

— Denis McDonough (@Denis44) February 8, 2016

The White House recently called for $1.1 billion dollars in the 2017 fiscal-year budget for the use of evidence-based opioid abuse and heroin use prevention programs, prescription drug take-back events, and prescription drug monitoring programs, among other tactics.

Regardless of whether pharmacists thought the commercial made a positive or negative impact, they can still help patients with constipation, which is defined as having fewer than 3 bowel movements per week.

Here are a few tips and facts that pharmacists can share:

1. Certain conditions that affect hormones can make patients more likely to experience constipation.

According to the Mayo Clinic, these conditions include:

• Diabetes
• Overactive parathyroid gland
• Pregnancy
• Underactive thyroid

2. Opioids aren’t the only medications that can cause constipation.

Constipation can be an adverse effect of some antidepressants, anticonvulsants, and antihistamines.

3. Some unmodifiable factors may make a patient more likely to be constipated.

For instance, females and older adults have an increased risk for chronic constipation, according to the Mayo Clinic.

4. Modifiable factors like hydration, fiber, and exercise can help relieve constipation.

Pharmacists can help patients remember to drink more water throughout the day and incorporate more fiber-rich foods into their diet.

Wheat, corn, rice bran, beans, berries, peas, dried figs and prunes, and avocados are a few foods that are high in fiber. Pharmacists should counsel patients to slowly start incorporating fiber-rich foods into their diet in order to avoid adverse effects. Some foods and beverages to avoid include tea, cheese, chocolate, white rice, and unripe bananas.

Little or no physical activity can also lead to problems, so pharmacists can encourage patients to walk at least 10 to 15 minutes several times a day if they are not fit. If patients are relatively fit, they can try running, swimming, or dancing.

5. Pharmacists can help patients choose a laxative that works for them.

Some options include fiber supplements, stimulants, osmotics, lubricants, and stool softeners.

6. If all else fails, prescription medications are available.

If OTC options aren’t doing the trick, patients may be prescribed medications like lubiprostone (Amitiza) and linaclotide (Linzess). The New York Times noted that these medications best serve patients who have constipation due to muscle weakness or a nerve problem.

The Super Bowl 50 commercial noted that OIC differs from regular constipation and may require a unique approach (eg, a drug like Movantik).

7. Another option for constipated patients is biofeedback therapy.

Biofeedback therapy involves pelvic relaxation and stimulated defecation training. One 2014 study published in the American Journal of Gastroenterology found that biofeedback therapy led to “sustained improvement of bowel symptoms and anorectal function” compared with patients who received 3 months of standard therapy involving diet, exercise, and laxatives.

8. Patients with constipation aren’t alone.

A recent JAMA article cited that the condition leads to 8 million annual visits to health care providers.