Diagnosis and Management of Opioid-induced Bowel Dysfunction in Patients with Advanced Cancer

Amanda Fredericks, BA, Genevieve Hollis, MSN, CRNP, AOCN, ANP-BC; Carrie Tompkins Stricker, PhD, RN

Clin J Oncol Nurs. 2010;14(6):701-704.

Abstract and Introduction

Abstract

Opioid-induced bowel dysfunction (OBD) is characterized by a constellation of symptoms, including constipation; dry, hard stools; straining; and incomplete evacuation. The use of a prophylactic bowel regimen that includes a stimulant laxative and stool softener generally is accepted and should be initiated at the start of opioid therapy. Effective prevention and treatment of OBD reduce the risk of associated physiologic complications and can improve pain management and quality of life for patients and their families.

Introduction

Opioid-induced bowel dysfunction (OBD) is a clinical syndrome characterized by slowed gastrointestinal motility (Thomas, 2008) that occurs in up to 90% of patients with advanced cancer receiving opioids (Sykes, 1998). Its predominant symptom, constipation, is defined as less than three defecations per week (or change from usual pattern), or the subjective symptom of difficult, infrequent, or incomplete passage of stool (McMillan, 2004; Reville, Axelrod, & Maury, 2009). OBD includes a constellation of gastrointestinal symptoms (see Figure 1); as a result, distinguishing OBD from other conditions can be difficult. In addition to being challenging to treat, the syndrome poses the risk for serious medical complications and can negatively impact pain management and quality of life (Bell et al., 2009).

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Figure 1.

Clinical Symptoms of Opioid-Induced Bowel Dysfunction
Note. Based on information from Kurtz & Sessler, 2003; Neyens & Jackson, 2007.

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