Download Management of constipation in adults excluding end of life care

Use of Laxatives in Constipation (adults)
See separate guideline for management of constipation in end of life care
Assess patient and identify possible causes
Short Duration (<2 weeks) or
Drug Induced Constipation
 Adjust any constipating
medication if possible.
 Advise the person about
increasing dietary fibre,
drinking an adequate fluid
intake, adjusting toileting
position and exercise.
vIf dietary measures are
ineffective, or while waiting for
them to take effect, start
treatment with
Macrogol sachets (£)
Dose: 1-3 sachets daily in
divided doses (ensure adequate
fluid intake)
If stools are soft but the person
still finds them difficult to pass
or complains of inadequate
emptying, add
Senna (£)
Dose: 7.5-15mg ON (start at
lower dose) or
Bisacodyl (£) 5-10mg ON
Advise the patients that
laxatives can be stopped once
the stools become soft and
easily passed again.
References:

Clinical Knowledge Summaries Guidance –
Constipation www.cks.nhs/constipation

NICE TA 221 Prucalopride for the symptomatic
treatment of chronic constipation in women
December 2010

NICE TA318 Lubiprostone in Chronic Idiopathic
Constipation

The management of constipation Merec Bulletin
Vol 21. No. 2 January 2011
Approved by HaRD APC January 2017
Chronic Constipation
 Relieve faecal loading/ impaction, if
present (see faecal impaction).
 Exclude underlying causes & review
causative agent(s) and refer if ‘red
flag’ signs for GI cancer.
Laxatives should be used as in
short-duration constipation.
 Adjust the dose, choice and
combination of laxative to
produce comfortable
defecation with soft, formed
stools once or twice a day.
 Regular use of a laxative may
also be needed to maintain
comfortable defecation.
A two week course of Lubiprostone
(££) should be considered for those
patients that have tried at least 2
different types of laxatives at the
highest possible doses for at least 6
months. Review treatment at two
weeks, continue with ongoing
prescriptions of the 4 week pack if a
suitable response is seen (>3 SBMs
per week).
Dose: 24mcg soft capsule taken
twice daily with food and water.
Prucalopride (£££) may be
considered as an option for women
with chronic constipation, who
have tried at least 2 different types
of laxatives at the highest possible
doses for at least 6 months without
relief and in whom clinicians are
considering invasive treatment.
Review treatment if no response
after 4 weeks
Dose: Initially 1mg OD increased to
2mg OD.
For men →refer to secondary care
Faecal Impaction
Hard Stools
Start treatment
with Macrogol
sachets (£)
Dose: 8 sachets
in 1 litre of
water drunk
over 6 hours.
(Not for more
than 3 days)
Soft Stools
For soft stools
start treatment
with Senna (£)
Dose: 15-30mg
ON or
bisacodyl (£)
5-10mg ON
If the response to oral laxatives is
insufficient or not fast enough.
Glycerol
suppository (£)
Dose: One 4g
suppository
moistened with
water before use
PRN
Sodium
Citrate rectal
Enema (£)
Dose: 5ml
PRN
If the response to is still insufficient
or not fast enough.
Sodium
phosphate
enema (£)
(place high if the
rectum is empty
but the colon is
full).
 Enemas may need to be
repeated several times to clear
hard impacted faeces.
 Regular use of a laxative may
also be needed to maintain
comfortable defecation.
At any stage, refer for further
examination if symptoms
persist or if any ‘red flag’
signs for GI cancer