A Combination of Senna Leaf Extract, Prune Fibre and Inulin Relieves Opioid-Induced Constipation and Regulates Gut Microbiota in Cancer Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

Background: Opioid-induced constipation (OIC) affects most cancer patients on chronic opioid therapy and is frequently
under-treated. Objective: To synthesise published evidence on senna, prune fibre and inulin, alone and combined, for OIC and gut
microbiota modulation in cancer/palliative populations. Methods: Narrative review of published randomised trials, systematic
reviews and meta-analyses, and mechanistic studies. Findings: Stimulant laxatives, bulking fruit fibre and prebiotic fructans each
improve stool frequency and consistency, and prebiotic fibre additionally enriches saccharolytic taxa and short-chain fatty acid
output, supporting rationale for combined use. Conclusions: A multimodal senna-prune fibre-inulin regimen is mechanistically
plausible and merits dedicated trials in opioid-treated cancer patients.