How long does it take for opioid-induced constipation to go away?

October 9, 2025 •

4 min read

Affecting between 40% and 81% of non-cancer patients on long-term opioid therapy, opioid-induced constipation (OIC) is a persistent side effect [1.3.2]. Understanding how long it take for opioid-induced constipation to go away depends on treatment and whether opioid use continues.

Quick Summary

Opioid-induced constipation (OIC) often lasts as long as you take the medication and may not improve on its own [1.2.3]. Resolution depends on stopping the opioid or using targeted treatments to manage symptoms.

Key Points

Persistent Condition: Opioid-induced constipation (OIC) typically lasts as long as you are taking the opioid medication and does not resolve on its own [1.2.1, 1.2.3].
Mechanism is Key: OIC is caused by opioids binding to mu-receptors in the gut, which slows motility and hardens stool, making it different from regular constipation [1.3.2, 1.3.7].
First-Line Treatments: Initial management includes lifestyle changes (fluids, fiber, exercise) and over-the-counter laxatives like stimulants and osmotics [1.4.1, 1.4.6].
Targeted Prescriptions: For persistent OIC, peripherally acting mu-opioid receptor antagonists (PAMORAs) like naloxegol or methylnaltrexone are recommended as they specifically block the opioid's effect in the gut [1.4.1, 1.5.1].
Consult a Doctor: It is important to discuss symptoms with a healthcare provider, as untreated OIC can impact quality of life and lead to complications [1.2.3, 1.6.5].
Cessation Leads to Resolution: If opioid medication is stopped (under medical supervision), bowel function will generally begin to normalize, though the timeline varies [1.2.9].
Avoid Bulk-Forming Laxatives: Bulk-forming laxatives like psyllium are generally not recommended for OIC as they can worsen abdominal pain and obstruction [1.4.6, 1.5.7].

Understanding Opioid-Induced Constipation (OIC)

Opioid-induced constipation (OIC) is one of the most common and distressing side effects for patients using opioids for pain management, with a prevalence ranging from 40% to over 80% [1.3.1, 1.3.2]. Unlike other opioid side effects to which the body may develop a tolerance, constipation often persists for the entire duration of opioid use [1.2.3]. This condition occurs because opioids bind to mu-opioid receptors in the enteric nervous system of the gastrointestinal (GI) tract [1.3.2]. This binding action inhibits gut motility, reduces fluid secretion into the bowel, and increases fluid absorption from the stool, leading to hard, dry stools that are difficult to pass [1.3.1, 1.3.8]. Furthermore, opioids can increase the anal sphincter tone, impairing the defecation reflex and contributing to a sensation of incomplete evacuation [1.3.1].

How Long Does OIC Last?

The primary factor determining how long OIC lasts is the continued use of the opioid medication. For most individuals, OIC will persist as long as they are taking the opioid and is unlikely to resolve on its own over time, even with dose reduction [1.2.1, 1.2.3]. Relief from OIC typically occurs through two main pathways:

Cessation of Opioid Therapy: Once a person stops taking opioids, their bowel function will generally begin to normalize. The exact timeline can vary depending on the individual, the type of opioid taken, the dosage, and the duration of use. Tapering off opioids can take weeks or even months, and during this time, withdrawal symptoms may occur, but GI function should gradually improve as the opioid's influence wanes [1.2.9].
Active Management and Treatment: If opioid therapy must continue for pain management, OIC requires active intervention. Relief is not guaranteed and can be slow even with treatment [1.2.5]. While lifestyle changes and over-the-counter (OTC) laxatives are often the first step, they frequently provide inadequate relief because they don't target the specific mechanism of OIC [1.3.2, 1.5.1]. Many patients (approximately 80%) report still being constipated despite using OTC laxatives [1.2.3].

Symptoms and When to See a Doctor

The symptoms of OIC go beyond just infrequent bowel movements. According to the Rome IV diagnostic criteria, a diagnosis may be considered with the new onset or worsening of at least two of the following symptoms after starting opioids [1.6.1, 1.6.4]:

Straining during more than 25% of defecations
Lumpy or hard stools (Bristol Stool Form Scale 1-2) for more than 25% of defecations
A sensation of incomplete evacuation for more than 25% of defecations
Sensation of anorectal blockage for more than 25% of defecations
Fewer than three spontaneous bowel movements per week
Needing to use manual maneuvers to facilitate defecation

It is crucial to speak with a healthcare provider if these symptoms develop. Many patients feel embarrassed to discuss constipation, but untreated OIC can lead to reduced quality of life, inadequate pain control (if patients reduce their opioid dose to relieve constipation), and serious complications like fecal impaction or bowel obstruction [1.2.3, 1.3.4]. You should seek immediate medical help if you experience severe abdominal pain, as this could be a sign of a rare but serious tear in the intestinal wall [1.6.8].

Management Strategies for OIC

Managing OIC effectively often requires a multi-faceted approach, starting with basic care and escalating to targeted prescription therapies if needed. Prophylactic treatment, such as starting a laxative regimen at the same time as the opioid, is often recommended [1.3.1, 1.4.4].

Comparing Treatment Approaches


Treatment Tier	Approach	Mechanism of Action	Effectiveness & Considerations
First-Line	Lifestyle & Diet	Increases fluid and fiber bulk, promotes motility.	Recommended for all, but often insufficient for OIC alone [1.4.6]. Includes 25-30g fiber daily, 1.5-2L fluids, and regular exercise [1.5.5]. Bulk-forming fibers like psyllium should be avoided as they can worsen pain if motility is low [1.4.6, 1.5.7].
First-Line	OTC Laxatives	Osmotics (e.g., Polyethylene Glycol): Draw water into the colon. Stimulants (e.g., Senna, Bisacodyl): Increase intestinal contractions [1.4.3].	Recommended as initial therapy along with lifestyle changes [1.4.1]. However, they don't target the root opioid mechanism and are often ineffective for many patients with OIC [1.3.2, 1.4.2].
Second-Line	Prescription Medications (PAMORAs)	Peripherally Acting Mu-Opioid Receptor Antagonists (e.g., Naloxegol, Methylnaltrexone, Naldemedine): Block opioid effects in the gut without affecting pain relief in the brain [1.5.1].	Specifically designed for OIC and recommended when laxatives fail [1.4.1, 1.5.4]. These drugs directly counteract the cause of OIC [1.4.2].
Second-Line	Other Prescriptions	Chloride Channel Activators (e.g., Lubiprostone): Increase intestinal fluid secretion to soften stool and improve transit [1.4.6].	Approved for OIC, it offers another mechanism for relief when other options are insufficient [1.4.6].

Conclusion

For individuals taking opioids, the answer to "How long does it take for opioid-induced constipation to go away?" is clear: it is unlikely to resolve without intervention. The condition will likely persist as long as the opioid medication is used [1.2.3]. While bowel function typically returns to normal after opioid cessation, this is not always a viable option for those with chronic pain. Therefore, proactive and targeted management is key. Starting with lifestyle modifications and OTC laxatives is a reasonable first step, but many patients will require prescription medications like PAMORAs, which are specifically designed to counteract the constipating effects of opioids in the gut [1.5.1]. Open communication with a healthcare provider is essential to find an effective treatment plan that relieves constipation without compromising pain management [1.6.5].

For further reading on OIC guidelines, you may find information from the American Gastroenterological Association insightful: https://www.gastrojournal.org/article/S0016-5085(18)34782-6/fulltext

Frequently Asked Questions

Not necessarily. OIC is not always dose-dependent and may persist even with a change or reduction in the opioid dosage. It often lasts for the entire duration of treatment [1.2.3, 1.3.3].

The first steps typically involve lifestyle and dietary changes, such as increasing fluid intake to 1.5-2 liters per day, consuming 25-30 grams of fiber, and regular exercise. A healthcare provider will also likely recommend starting an over-the-counter laxative, like an osmotic or stimulant laxative [1.4.6].

While OTC laxatives are the recommended first-line therapy, they are often not sufficient for many people with OIC because they do not target the underlying cause. Studies show that a high percentage of patients using OTC laxatives still experience constipation [1.2.3, 1.3.2].

PAMORA stands for Peripherally Acting Mu-Opioid Receptor Antagonist. These are prescription medications (like naloxegol, methylnaltrexone, and naldemedine) that specifically block the effects of opioids on the receptors in your gut, helping to relieve constipation without interfering with the pain-relieving effects in your brain [1.5.1, 1.4.6].

You should talk to your doctor as soon as you experience new or worsening constipation symptoms after starting an opioid. It is especially important to seek medical advice if OTC treatments are not working or if you experience severe abdominal pain, bloating, nausea, or vomiting [1.6.4, 1.6.5].

Bulk-forming laxatives like psyllium are generally not recommended for OIC. Because opioids reduce gut motility, adding bulk can worsen abdominal pain and potentially lead to obstruction [1.4.6, 1.5.7].

After you stop taking opioids (always under a doctor's supervision), your bowel function should start to return to normal. The exact timeline can vary from a few days to several weeks, depending on factors like the duration and dose of opioid use [1.2.6, 1.2.9].