Constipation

K59.0 + (Z51.5)

See: Constipation.

• Description
• General measures
• Medicine treatment
• Referral

DESCRIPTION

The underlying cause of constipation in palliative care patients may be functional, disease, or treatment related. Developmental disorders with or without cognitive deficits, mood and situational circumstances can impact bowel habits in chronically ill children.

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, and provide laxatives prophylactically.

MEDICINE TREATMENT

Adults and children > 15 years of age

• Sennosides A and B, oral, 13.5 mg, 1 tablet at night.
  • In resistant cases increase to 2 tablets.

LoEIII [1]

AND/OR

• Lactulose, oral, 10–20 mL 12–24 hourly.

LoEIII [2]

Children > 12 months of age

• Lactulose, oral, 0.5 mg/kg/dose once daily. See Paediatric dosing tool.
  • If poor response, increase frequency to 12 hourly.

LoEIII [3]

Note: Manual removal should only be undertaken if the patient has received adequate pain relief and if need be sedation as well.

For management of opioid-induced constipation:

See adjuvant therapy in Chronic cancer pain.

REFERRAL

• All patients with suspected bowel obstruction.
• Patients with severe constipation, not relieved with oral treatment, or who are unable to swallow.