29th December 2024

Constipation

Common causes of constipation in the palliative care context include drugs, direct effects of the disease and secondary effects of the disease.

When initiating a drug likely to cause constipation (e.g. an opioid), a pre-emptive prescription of a stimulant laxative (e.g. senna) should be considered.

Reversible contributing factors include diet, dehydration, environment (particularly privacy and bedpan use), haemorrhoids or fissures and local tumour.

Management includes:

• Stimulant laxative (senna)
• Addition of a stool softener if needed – osmotic (lactulose, macrogol) or stool-softening laxatives (docusate)
• Consider rectal treatments if the rectum is full:
  • Soft loading – bisacodyl or sodium citrate
  • Hard loading – glycerol

Although phosphate enemas are commonly used, NICE guidelines advise to avoid them as they cause water and electrolyte imbalances.

Rectal interventions should not be carried out on those on chemotherapy who may be neutropenic, those with thrombocytopenia, and those with rectal or anal disease.