Management of Opioid-Induced Constipation in Patients with Diverticulitis

First-Line Treatment

The American Gastroenterological Association (AGA) strongly recommends traditional laxatives as first-line agents for opioid-induced constipation, with moderate quality evidence supporting this approach 1, 2
Initiate prophylactic laxatives immediately when starting opioids, using a stimulant laxative (bisacodyl or senna) combined with an osmotic agent (polyethylene glycol) 1, 3, 4
Target one non-forced bowel movement every 1-2 days, and use the Bowel Function Index to assess severity 3, 4

The AGA strongly recommends naldemedine and naloxegol as second-line treatments for laxative-refractory cases, with high-quality and moderate-quality evidence, respectively 1, 2
Methylnaltrexone is conditionally suggested as a second-line treatment, with low-quality evidence 6, 3

Do not use stimulant laxatives during acute diverticulitis with active inflammation, and prefer osmotic laxatives (PEG) as monotherapy until inflammation resolves 1, 2
Always exclude mechanical obstruction, perforation, or abscess before initiating any laxative therapy 1, 6, 4

Increase fluid intake when appropriate, and encourage physical activity if the patient's condition permits 3, 4
Ensure privacy and comfort for defecation, and consider abdominal massage and proper positioning 4