K59.0 + (Z51.1)
DESCRIPTION
Constipation is the passage of small, hard faeces infrequently and with difficulty. Individuals vary in the weight they give to the different components of this definition when assessing their own constipation and may introduce other factors, such as pain and discomfort when defecating, flatulence, bloating or a sensation of incomplete evacuation. Constipation may also be secondary to other conditions e.g. dehydration, immobility poor diet, anorexia, tumour compressing bowel wall or hypercalcaemia.
GENERAL MEASURES
Ensure privacy and comfort to allow a patient to defecate normally.
Increase fluid intake within the patient’s limits.
Encourage activity and increased mobility within the patient’s limits.
Anticipate the constipating effects of pharmacological agents such as opioids, anticholinergic agents (e.g. tricyclic antidepressants), antacids, iron, 5HT3 antagonists and provide laxatives prophylactically.
MEDICINE TREATMENT
The combination of a softener and stimulant laxative is generally recommended, and the choice of laxatives should be made on an individual basis.
- Sennosides A and B, oral, 13.5 mg, 1 tablet at night.
- In resistant cases increase to 2 tablets.
AND/OR
- Lactulose, oral, 15–30 mL 12–24 hourly.
Severe constipation in patients who are unable to swallow:
- Bisacodyl, rectal, 10 mg suppository daily.
OR
- Glycerine (glycerol), rectal, 1.698 mL/2.4 g suppository when necessary.
If these therapies are not effective, other options could be considered.
Note: Manual removal should only be undertaken if the patient has received adequate pain relief and sedation, if relevant.
REFERRAL/CONSULTATION
If bowel obstruction is suspected refer/consult for appropriate radiological investigations and, if appropriate, surgical interventions.