Constipation Management Flashcards
Outline the management of short-duration constipation where where dietary measures are ineffective
1) Bulk-forming laxative first line -ensure adequate fluids
■ If stools remain hard, add or switch to an osmotic e.g. macrogol If not tolerated, offer lactulose as second-line.
■ If soft but difficult to pass or inadequate emptying, a stimulant laxative should be added.
How should opioid induced constipation be managed?
1) Osmotic laxative (or docusate sodium to soften the stools) and a stimulant laxative is recommended.
↳ Bulk-forming laxatives should be avoided
2) Naloxegol is recommended for opioid-induced constipation if other laxatives fail
The treatment of faecal impaction depends on the stool consistency. explain how hard faecal impaction is managed
1) Hard stools: prescribe high dose oral macrogol
2) If stool remains hard after a few days of treatment consider starting or add an oral stimulant laxative.
3) If response still inadequate:
■Glycerol alone, or glycerol plus bisacodyl suppositories
■ or docusate sodium or sodium citrate enema
4) Inadequate response: phosphate enema or arachis oil retention enema may be necessary
Outline how soft faecal impaction is managed
1) Oral stimulant laxative
2) Inadequate response : Rectal administration of bisacodyl
3) If the response is still insufficient, phosphate or arachis oil retention enema may be necessary. 7
↳ (Enemas may need to be repeated several times to clear hard impacted faeces)
how should chronic constipation be managed?
1) Bulk-forming laxative- Ensure good hydration
2) If still hard, add or change to an osmotic laxative such as a macrogol. Lactulose is an alternative if not tolerated
3) if still inadequate, add stimulant laxative
in constipation the dose of laxative should be adjusted gradually, with the aim to achieve what ?
produce one or two soft, formed stools per day
How should chronic constipation be managed if at least two laxatives (different classes) have been tried at the highest tolerated recommended doses for 6 months?
Prucalopride (in women only) should be considered. Review in 4 weeks and withdraw if ineffective
when regular bowel movements reoccur, how should laxatives be withdrawn?
1) Withdraw slowly, according to consistency and frequency
2) Reduce and stop one laxative at a time; if possible, the stimulant laxative should be reduced first. But, it may be necessary to also adjust the dose of the osmotic laxative to compensate.
outline the management of constipation in pregnancy if dietary and lifestyle changes fail and fibre supplements in the form of bran or wheat is inadequate
1) Bulk-forming laxative first line during pregnancy if fibre supplements fail
2) ■ If stools remain hard, add or switch to an osmotic laxative, such as lactulose
■ If stools are soft but difficult to pass, consider a short course of a stimulant e.g. Senna or Bisacodyl
3) If still inadequate, prescribe glycerol suppository
when should senna be avoided in pregnancy?
Avoid near term or if there is a history of unstable pregnancy
how should constipation be managed in breastfeeding ?
1) bulk-forming laxative is the first choice, if dietary measures fail.
2) Lactulose or a macrogol may be used if stools remain hard. As an alternative, a short course of a stimulant laxative such as bisacodyl or senna can be considered.
why is early identification of constipation in children important?
Without early diagnosis and treatment, an acute episode of constipation can lead to anal fissure and become chronic
How does first line treatment for constipation in children, differ from that of adults?
use of a laxative in combination with dietary modification or with behavioural interventions. Diet modification alone is not recommended as first-line treatment.
In children an increase in dietary fibre, adequate fluid intake, and exercise is advised in constipation. which foods are recommended and which ones should be avoided in constipation?
1) fruits, and vegetables, high-fibre bread, baked beans, and wholegrain breakfast cereals.
2) Unprocessed bran (which may cause bloating and flatulence and reduces the absorption of micronutrients) is not recommended.
how should constipation be managed in children if faecal impaction is not present (or has been treated)?
1) Macrogol first-line:e.g. CosmoCol/Movicol/Laxido Paediatric
2) If inadequate, add a stimulant laxative or change to a stimulant laxative if the first-line therapy is not tolerated.
3) If still hard, lactulose or docusate can be added
