Common with opioids and reduced activity in advanced illness.
Best position to expel stool: raise knees above your waist – use foot stool or books.
Food: clinical trial showed kiwi’s > prunes > psyllium improved constipation, but kiwis also reduced bloating.
Prevent constipation from opioids through daily use of laxative.
Medications
Osmotic laxative
- PEG 3350 17-34g in juice daily
- lactulose 15-30ml daily or bid
Stimulant
- senna 1-3 tabs daily to bid
Suppository
- glycerin or bisacodyl
Other medications
- docusate not supported by evidence
- psyllium requires ++fluids to work and not recommended in advanced disease
Opioid induced constipation unresponsive to above, add
- methylnaltrexone 8-12mg sc q2days.
Refractory constipation GI secretagogue:
- Prucalopride 1mg once daily 30 min prior to morning meal. May increase to 2mg daily except in renal failure.
Other therapies
Encourage:
- regular bowel routine
- privacy
- activity if possible
- oral fluids
Enema
- saline enema still useful to remove hard stool