TREATMENT OF EXISTING 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.