Patient group in constipation

Question 1

Opioid induced constipation treatment

Answer 1

1st Osmotic or docusate +stimulant

In palliative care = co-danthramer or co-danthrusate

If unresponsive opioid receptor antagonists like naloxegol, methynaltrexone

Question 2

What laxative to avoid in opioid constipated

Answer 2

Bulk forming due to obstruction and colic

Question 3

Chronic constipation

Answer 3

same laxative treatment (short term) but in osmotic laxative macrogol is choice

Question 4

constipation in children

Answer 4

1st line macrogols if dietary/behaviour intervention fail
2nd line stimulant
then add lactulose or stool softeners if still hard

Question 5

constipation in pregnancy

Answer 5

1st line bulk if diet fails
2nd line osmotic
3rd stimulant Senna or bisacodyl (avoid Senna at term; can give uterine contractions)
4th glycerol suppository or docusate

Question 6

constipation in breast feed

Answer 6

1st line = bulk forming
2nd = lactulose or macrogol if still hard
alt; stimulant e.g. bisacodyl or Senna