Constipation (Guidelines)

Beware: constipation, a common symptom, but it sometimes heralds a surgical emergency.  

Click here for PDF version of flowchart

General aim should be to move bowels three times per week. If not moved after 2 days in hospital, assessment for constipation required.

Consider the following throughout admission:

Non-pharmacological

• Dietary advice
• Prunes and porridge
• Fruit/ Fruit juice (caution in diabetes)
• Dietary fibre intake (menu choices)
• Aiming 1.5 to 2 litres of fluid daily
• Hot, decaffeinated drinks
• Maintain activity as able

Best position

Consider timing: 30 minutes after breakfast and hot drink
Try to avoid delay when the urge develops, and avoid rushing the person

Undertake medication review

Identify constipating medicines including:

• Aluminium containing antacids
• Antidiarrhoeals
• Iron and calcium supplements
• Opioid analgesics
• Calcium channel blockers: diltiazem
• Antimuscarinics: oxybutynin, amitriptyline, imipramine
• Antipsychotics: amisulpride, chlorpromazine
• Gabapentin/pregabalin, carbamazepine, etc

Medical review including PR

Consider laxatives:

• FIRST LINE: Laxido©  (osmotic laxative)
  Usual starting dose of 1 sachet twice daily
• SECOND LINE: docusate (softener) or sennosides (stimulant) and treat as per usual

Suppositories/enemas

Where stools are soft but difficult to pass (or no enteral route available) use bisacodyl suppositories 10mg daily and/or glycerol suppositories 4g daily

For hard stools use sodium phosphate retention enema or Micralax Micro-enema in morning

Printable poster

Ward Bowel Chart