1. Identify the cause of constipation.
Constipation should be anticipated in all patients who are:
- Taking opioids (Opioid Induced Constipation) or anticholinergics (e.g. tricyclic antidepressants, cyclizine, etc.).
- Either inactive or have a reduced fluid or dietary fibre intake.
For new constipation also consider:
- Risk of hypercalcaemia which could be treated.
- Bowel obstruction – if clinically suspected, seek further advice.
Lack of privacy and pain may be contributing factors.
2. Management should then be guided by clinical assessment.
Ask about patient’s past and present bowel habit, and use of laxatives. Record date of last bowel action and brief description of type and volume of stool, whether straining is required – aim is for a bowel action without straining every 1-3 days.
Palpate for faecal masses in the line of the colon; examine the rectum digitally if the bowels have not been open for ≥3 days; if the patient reports rectal discomfort or has diarrhoea suggestive of faecal impaction with overflow.
Disclaimer
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.