Can constipation cause nausea and vomiting?

From the Guidelines

Constipation can indeed cause nausea and vomiting, as evidenced by the development of nausea, vomiting, and other complications in patients with constipation, particularly in those with advanced cancer 1.

Key Points to Consider

• Constipation may lead to nausea and vomiting due to the buildup of stool in the intestines, creating pressure and discomfort that affects the entire digestive system.
• The vagus nerve, which connects the gut and brain, can be triggered by this backup, leading to feelings of nausea and sometimes vomiting.
• Additionally, the buildup of waste materials can cause toxins to be reabsorbed into the bloodstream, further contributing to these symptoms.
• Opioid-induced constipation (OIC) is a specific condition that can cause constipation, nausea, and vomiting, and is estimated to affect 40%–80% of patients taking chronic opioid therapy 1.

Management and Treatment

• To address constipation and its associated symptoms, increase fluid intake to 8-10 glasses of water daily, add fiber-rich foods gradually to your diet, and engage in regular physical activity.
• Over-the-counter options like docusate sodium (Colace) 100mg twice daily or polyethylene glycol (Miralax) 17g in water once daily can provide relief.
• If symptoms persist beyond two weeks, include severe abdominal pain, or you notice blood in your stool, seek medical attention as these could indicate a more serious condition requiring professional evaluation.

From the FDA Drug Label

The most common adverse reactions (>4%) in CIC were nausea, diarrhea, headache, abdominal pain, abdominal distension, and flatulence Nausea: Approximately 29% of patients who received lubiprostone experienced nausea; 4% of patients had severe nausea and 9% of patients discontinued treatment due to nausea. Vomiting 0 3 The most common adverse reactions (>4%) in OIC were nausea and diarrhea Vomiting 2 3

Constipation does not directly cause nausea and vomiting according to the provided drug label. However, nausea and vomiting are reported as adverse reactions in patients treated with lubiprostone for constipation.

• Nausea is experienced by approximately 29% of patients with CIC and 11% of patients with OIC.
• Vomiting is experienced by 3% of patients with CIC and 3% of patients with OIC 2.

From the Research

Constipation and Nausea Vomiting

• Constipation is a common complaint that can lead to various symptoms, including nausea and vomiting 3, 4, 5.
• Studies have shown that treatment of constipation with polyethylene glycol (PEG) can lead to adverse events such as nausea and vomiting, although these effects are generally mild or moderate in severity 5, 6.
• The use of PEG in functional constipation and fecal impaction has been evaluated in several studies, which have reported that PEG is effective and safe for chronic constipation and for resolving fecal impaction in children and adults 3, 4.
• In a study of chronic polyethylene glycol laxative use in chronic constipation, medication-associated adverse effects included gastrointestinal complaints of diarrhea, loose stool, flatulence, and nausea, which were generally mild or moderate in severity 5.
• Another study found that oral administration of 17 g PEG 3350 once daily for a week is effective, safe, and well tolerated in subjects with occasional constipation, with adverse events balanced between the PEG 3350 and placebo groups 6.
• A post hoc analysis of a multicenter, double-blind, placebo-controlled trial found that once-daily polyethylene glycol 3350 demonstrated substantial and sustained efficacy and safety over 24 weeks in patients with chronic idiopathic constipation, with a decrease in gastrointestinal adverse events after the first week of treatment 7.

Adverse Events

• Nausea and vomiting are potential adverse events associated with the treatment of constipation with PEG 5, 6.
• Other adverse events reported in studies of PEG use in constipation include diarrhea, loose stool, flatulence, and abdominal pain 3, 4, 5, 6.
• The severity of these adverse events is generally mild or moderate, and they are often well tolerated by patients 5, 6.