Constipation
Gastrointestinal Conditions
K59.0 + (Z51.5)
See: Constipation, Gastrointestinal Conditions
DESCRIPTION
The underlying cause of constipation in palliative care patients may be functional, disease, or treatment related. Developmental disorders with or without cognitive deficits, mood and situational circumstances can impact bowel habits in chronically ill children.
GENERAL MEASURES
Ensure privacy and comfort to allow a patient to defecate normally.
Increase fluid intake within the patient’s limits.
Encourage activity and increased mobility within the patient’s limits.
Anticipate the constipating effects of pharmacological agents, such as opioids, and provide laxatives prophylactically.
MEDICINE TREATMENT
Adults and children > 15 years of age
- Sennosides A and B, oral, 13.5 mg, 1 tablet at night.
- In resistant cases increase to 2 tablets.
LoE:IIb2
AND/OR
- Lactulose, oral, 10–30 mL, 12–24 hourly
LoE:IIb3
Children
- Lactulose, oral, 2.5–10 mL 12 hourly.
- If poor response, increase frequency to 12 hourly.
LoE:IIb4
Note:
Manual removal should only be undertaken if the patient has received adequate pain relief and, if necessary, sedation as well.
For management of opioid-induced constipation:
- See adjuvant therapy in Chronic cancer pain
REFERRAL
- All patients with suspected bowel obstruction.
- Patients with severe constipation, not relieved with oral treatment, or who are unable to swallow.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 22: Medicines Used in Palliative Care_22.1 Gastrointestinal Conditions_22.1.1 Constipation