You are called to the ward at night because a patient is in distress and wants treatment for constipation.
- What options do you have to treat this?
Constipation in the hospital setting can occur for many reasons – pre-existing, medication/opiate-induced, low fibre diet, systemic disease (i.e. Parkinsonism), or even more acutely with ischemic gut. First step to managing constipation is identifying the underlying cause.Treatment options include:- Stool softener – docusate sodium (Colace)
- Osmotic agents – PEG, magnesium-citrate based products, sodium phosphate products, lactulose
- Stimulant laxitives – bisadocyl (dulcolax), glycerine suppository, senna
- Enemas – mineral oil, tap water, phosphate enema (fleet)
- Manual disimpaction
- What would be your first choice treatment in this case?
Treatment should start with PEG (time of onset 0.5-1hr, and evidence of greater efficacy than lactulose). Give no more than 250cc PEG the first time. A glycerine suppository can also be given to reduce irritation of hard or large stools.This patient should then be given a stimulant laxative (i.e. Senna) daily for constipation.The underlying cause should always be sought and treated.
Resource
Bharucha AE, Pemberton JH and Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013, 144:218-238.
