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prevention of constipation

  • encourage good fluid intake with adequate dietary fibre
  • avoid repression of desire to use bowels
  • encourage regular bowel habits
  • increasing dietary fibre to the recommended daily intake of approximately 30 g or the use of fibre supplements such as psyllium should help in those patients with fibre deficiency.
    • BUT excessive dietary fibre will result in bloating, cramps, flatulence due to fermentation in the colon.
  • adequate exercise
  • reduce stress
  • avoid medications which cause constipation if possible:
  • warn patients to take extra care and consider simple prophylactic laxatives such as coloxyl with senna if they must take these medications or they are at risk (eg. painful anal conditions or prolonged bed rest)

red flag alarm signals for diagnosis of constipation in adults

medical Rx of constipation

  • if there is fecal impaction, this should be relieved BEFORE discharging patient home:
    • consider Fleet enemas x 1-2 if no C/I
      • phosphate enemas may cause volume depletion, hypotension, hypokalaemia, hypocalcaemia, hyperphosphataemia (especially if impaired renal function)
    • in elderly patients, daily 100mL warm water enemas are safer than phosphate enemas (Fleet, etc)
    • may require medical admission to hospital for Rx with oral Go-Lytely &/or manual disimpaction

oral stool softeners

  • docusate
    • 240mg (2 x 120mg tablets) daily
    • takes 1-3 days to work
    • can be used in pregnancy

oral bulking agents

  • useful if there is a dietary fibre deficiency
  • onset is usually by 24 hours, with peak action at 2-3 days following dosing
  • Ispaghula
    • 1 sachet or teaspoon in water
  • Psyllium
    • as directed on packet, 1- 3 times a day
    • can be used in pregnancy
  • Sterculia
    • 1–2 teaspoons 1–2/day

oral osmotic agents

  • lactulose (Duphalac)
    • 15-30ml once or twice a day
    • takes 1-2 days to work
    • can be used in pregnancy
  • other agents

oral stimulant laxatives

  • avoid long term use as they may induce melanosis coli, tolerance or cathartic colon and there is little evidence for their efficacy.
  • not proven to be safe in pregnancy
  • Bisacodyl
    • 1–2 x 5 mg tablets daily
    • works in 6-12hrs
    • can be used in pregnancy
  • sennosides
    • works in 6-12hrs

Rx of chronic refractory constipation in adults

constipation.txt · Last modified: 2019/06/27 13:31 (external edit)