TREATMENT OF EXISTING CONSTIPATION

Use the information in this section to aid in the treatment of constipation.

Is the rectum impacted?

Yes with hard stool

Lubricate using glycerol suppositories or soften with oil enema followed by stimulant e.g. phosphate enema once softened.

Once impaction is resolved commence or increase a laxative combining stimulant and softening actions.

Yes stool is soft

Use a rectal stimulant, e.g. bisacodyl suppositories or phosphate enema.

Once impaction is resolved commence or increase a laxative combining stimulant and softening actions.

If no success using measures above

Commence a Macrogols preparation at faecal impaction dose.

Manual evacuation (consider sedation).

Is the rectum empty?

The rectum is empty

May still be constipated with a loaded colon.

Stimulant laxative may be of benefit (but avoid in patients with severe colic).

Consider bowel obstruction.

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.