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CDHB

Constipation

General Measures

• PR examination (a plain abdominal X-ray may be required).
• Look for possible causes - pregnancy, cancer, hypothyroidism, hypercalcaemia, drugs.
• Avoid constipating drugs (e.g., codeine, opiates, tricyclics, anticholinergics, calcium channel blockers, aluminium hydroxide).
• Dietary control e.g., increase fluid, fibre, fruit.

Specific Measures

• Increase fluid intake.
• Bulking agents (e.g., mucilax, metamucil). If no response then consider:
  • Faecal softeners (e.g., docusate).
  • Lactulose has an osmotic effect but may cause excess flatulence and bloating.
  • Colonic stimulants (e.g., bisacodyl, senna) useful in acute constipation. Side effects include cramps, electrolyte imbalance, melanosis coli, and "cathartic colon" and should not be used long term.
  • Bowel washout with Picosalax or (if less severe) Movicol or other agents may be needed. This procedure is relatively contraindicated in the elderly.
  • Glycerine suppositories/manual evacuation for faecal impaction.

Topic Code: 1420