Constipation is a common concern for many people beginning a new medication, and steroids are no exception. In a medical context, “steroids” typically refers to corticosteroids, which are powerful anti-inflammatory drugs used to treat conditions like asthma, arthritis, and autoimmune disorders. Many individuals using these medications experience a change in their digestive function, often involving a slowing of the bowels. Understanding this connection is key to effectively managing discomfort and maintaining digestive health while on a steroid regimen.
Which Steroids Cause Constipation
The primary group of medications linked to constipation is the corticosteroids, such as prednisone, dexamethasone, and hydrocortisone. While not universally reported, constipation occurs in a notable percentage of patients, sometimes reported in about 1% of those taking prednisone. This effect is often an indirect consequence of the drug’s action on the body’s internal balance, and higher doses or longer treatment durations may increase the likelihood of a digestive slowdown.
It is important to differentiate corticosteroids from anabolic-androgenic steroids (AAS), which are synthetic variations of testosterone used to promote muscle growth. Anabolic steroids can also cause gastrointestinal upset, but through different mechanisms, such as altering the gut microbiome. For the average patient taking steroids for an inflammatory condition, the concern about constipation relates almost exclusively to the corticosteroid class of drugs.
How Steroids Affect Digestion
Corticosteroids influence bowel function primarily by disrupting the body’s fluid and electrolyte balance. These medications promote the retention of sodium while causing the body to excrete more potassium. A lower-than-normal level of potassium (hypokalemia) impairs the function of smooth muscles, including those in the intestinal walls. This reduces peristalsis, the muscular contractions that move waste through the intestines, leading to slower transit time.
The slowed movement of waste through the colon allows the body more time to absorb water from the stool. This results in harder, drier stool that is difficult to pass. Some evidence suggests that corticosteroids can also directly affect gastrointestinal motility by altering signals sent to the digestive tract muscles.
Managing Constipation Caused by Steroids
Hydration and Diet
Managing this type of constipation requires a proactive approach focused on restoring hydration and promoting healthy gut movement. Increasing fluid intake is the most important initial step, as the body’s altered fluid balance requires more effort to keep the stool soft. Aiming for eight to ten glasses of water daily helps counteract the dehydrating effect and ensures the stool retains enough moisture to pass easily.
Dietary adjustments are also effective, particularly by increasing the consumption of fiber-rich foods to around 25 to 30 grams per day. Soluble fiber helps soften the stool, while insoluble fiber adds bulk to stimulate intestinal contractions.
Lifestyle and OTC Relief
Regular physical activity, such as walking or light aerobic exercise, helps stimulate the muscles of the gut and encourages more frequent bowel movements. If dietary and lifestyle changes are not sufficient, certain over-the-counter options may provide relief.
Bulk-forming laxatives (like psyllium) and stool softeners (such as docusate sodium) are generally considered safe starting points. It is important to discuss any new medication, including laxatives, with a healthcare provider while taking steroids to avoid potential interactions. Stimulant laxatives should be used sparingly and only under medical guidance.
When to Talk to a Doctor
While mild constipation is often manageable at home, certain signs warrant immediate medical consultation while on a steroid regimen. Contact your provider if constipation persists for more than a few days despite active management, or if it is accompanied by severe abdominal pain. A sudden inability to pass gas or stool may indicate a serious issue, such as an intestinal obstruction.
Urgent symptoms include vomiting, a severely bloated abdomen, or finding blood in the stool. These symptoms suggest a complication that requires prompt evaluation. Discussing any change in regular bowel habits with the prescribing physician ensures the medication dosage is appropriate and the digestive issue is addressed.