Can steroids cause constipation?

Steroids and Constipation

Steroids are not typically associated with constipation and may actually cause the opposite effect of diarrhea in some patients due to their effects on gastrointestinal function. 1

Gastrointestinal Effects of Steroids

Steroids can affect the gastrointestinal tract in several ways:

Primary Effects

• Steroids are more commonly associated with increased risk of peptic ulcers and gastrointestinal bleeding, especially when used long-term 1, 2
• They can cause electrolyte abnormalities that may affect bowel function 2
• In neurological patients, steroids have been associated with gastrointestinal perforation, particularly in the rectosigmoid area when combined with constipation 3

Secondary Effects on Bowel Function

• Steroids can cause fluid retention which may affect overall fluid balance
• They may cause hyperglycemia which can affect osmotic balance 1
• Long-term use can lead to metabolic changes that indirectly affect bowel function

Steroid Side Effect Profile

Steroids have numerous documented side effects, but constipation is not prominently listed among them. The British Society of Gastroenterology guidelines list the following major side effects of steroids 1:

• Increased infection risk
• Osteoporosis
• Suppression of the hypothalamic-pituitary-adrenal axis
• Diabetes
• Weight gain
• Cardiovascular disease
• Lipodystrophy
• Hypertension
• Sleep disturbances
• Mood disorders
• Cataracts
• Adrenal insufficiency

Additional side effects documented in clinical practice guidelines include 1:

• Myopathy
• Impaired wound healing
• Peptic ulcers
• Ophthalmologic disorders
• Skin disorders and alopecia
• Menstrual disorders and hormonal changes
• Avascular necrosis
• Pancreatitis

Constipation Management in Steroid Users

If a patient on steroids develops constipation, it's important to:

1. Consider other causes of constipation, as it's likely not directly related to steroid use
2. Evaluate for other medications that may cause constipation (opioids, anticholinergics)
3. Assess for dehydration or electrolyte abnormalities that may be indirectly related to steroid use
4. Consider that constipation in patients on steroids for inflammatory bowel disease may be related to:
   • Proximal colonic stasis in patients with distal colitis 1
   • Abnormal intestinal motility
   • Other medications being used concurrently

Prevention of GI Complications in Steroid Users

For patients on steroids, particularly those at high risk:

• Use the lowest effective dose for the shortest duration possible 1
• Consider prophylaxis with H2 blockers or proton pump inhibitors for those at high risk of GI side effects 1
• Monitor for signs of GI complications
• Prevent constipation in neurological patients on steroids to reduce risk of rectosigmoid perforation 3

Conclusion

While steroids have many well-documented side effects affecting multiple body systems, constipation is not typically considered a direct side effect of steroid therapy. If constipation occurs in a patient on steroids, other causes should be investigated, including concurrent medications, underlying conditions, or indirect effects of steroid therapy on fluid and electrolyte balance.