Constipation
Questions
- When did bowels/stoma last move?
- What is normal bowel habit?
- What medications are you taking and any recent changes?
- What has your food and fluid intake been like over the last few days?
- Any nausea or vomiting?
- Any increasing abdominal pain?
Note any signs of MSCC or hypercalcaemia
Grade 1 (Green)
No bowel movements in the last 24 hours
Advice
Dietary advice
Encourage fluid intake
Rationalise medications and remove constipating drugs
Laxatives; Movicol or laxido type
Patient to re-contact service if issue not resolved
Grade 2 (Amber)
No bowel movements in the last 48 hours
Advice
Dietary advice
Encourage fluid intake
Rationalise medications and remove constipating drugs
Laxatives; Movicol or laxido type
Patient to re-contact service if issue not resolved
Grade 3 (Red)
No bowel movements in the last 72 hours
Advice
Review all medication Including opiates
Dietary advice & good fluid intake
Consider admission if:
- Abdominal pain
- Nausea/vomiting
Surgical review if needed
Grade 4 (Red)
No bowel movements in the last 96 hours
Advice
Associated with:
- Severe abdominal pain
- Distension
- Nausea/vomiting
- Faecal vomiting
- Tender, rigid abdomen
Admit:
- Senior review
- Radiological imaging
- Surgical review if needed
- Analgesia
- IV access and fluids
Handover management with patient’s team, discuss all interruptions of treatment with team +/- AOS prior to proceeding.
Arrange follow up review as necessary.
Initial assessment – patient seen in AOCU
- History of complaint – Include other chemotherapy and radiotherapy toxicities
- Drug History- check if on Vinca Alkloids / 5HT-3 receptor antagonist antiemetics or opioids
- Abdominal examination +/- abdominal XR as needed
- Full set of vital Signs- Assess fluid balance status
- Bloods- FBC, renal function, CRP
Treatments
Self Help Advice
- Eat foods high in fibre like fruits (pears, prunes), cereals, and vegetables.
- Drink two to three litres of non-alcoholic fluids (water, juices) each day; unless you are told otherwise by your doctor.
- Exercise twenty to thirty minutes most days of the week, as tolerated, and if okay with your doctor. A lot of patients find that walking for exercise is convenient and easy to do.
- If you have been prescribed a “bowel regimen,” make sure you follow it exactly.
Medications – 1st line
- Movicol/Laxido 1-3 sachets. Movicol/Laxido is an osmotic laxative
- Senna 2 tablets bd. Senna is a stimulant laxative
2nd line
- Consider increasing the Movicol/Laxido. Can have up to 8 sachets per day.
- Sodium Docusate 200mg bd – Sodium docusate is both a stimulant and a softener.
If constipation is not resolved following 1st and 2nd line treatment, even if the patient is only mildly symptomatic, they may need admission for phosphate enemas.
