Constipation
Constipation is a common cause of ED presentation – with nausea, vomiting, abdominal pain and cramping – sometimes with impaction and obstipation. Constipation is most frequently opioid-induced: opioids cause constipation by decreased motility and decreased mucus secretion in the large bowel.
Important Note
Constipation is a potentially life-threatening entity (bowel-perforation, delirium) with a large burden of discomfort: care should be taken to ensure it is resolved before discharge home.
Managing Constipation:
- A digital exam to see if there is stool in the rectal vault
- Disimpaction –use a glycerin suppository one hour in advance to soften the stool
- High enemas (soap suds)
- Osmotic carthartics: polyethylene glycol (GoLytely), magnesium citrate (Citro-Dan)
Discharge management:
- Start with Sennosides (2 tablets or 15 mL at bedtime); or Bisacodyl (1-2 tablets nightly); increase each by 50% each night ’til effective; high doses may be required to overcome the opioid-induced loss of motility.
- PEG 3350 (1-2 sachets to start); or Lactulose 30 mL in the morning; double the dose daily ’til effective; or MagCitrate.
- Fibre and bulk-forming supplements (©Metamucil) are of little benefit in opioid constipation or patients with advanced disease.
Discussion: Constipation
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PO naloxone can also be useful for narcotic induced constipation
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There is a serious satchel of pearls on this page!
nice
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GI bleeding is often fatal to geriactric pts
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Thank you very much!
important for sbo prevention
adietrich
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great learning
Good information
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ok yes
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interesting
good information
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good info to have
good info
good
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Je n’utilisait pas ces recettes exactement (suppositoire une heure avant fecalome, 2 senokot hs, etc) tres utilse!
Muy importante porque es un síntoma común en pacientes tratados con opioides
should manage constipation to help before discharge
k
like the suggestion of the glycerin suppository prior to disimpaction. I have also used lidocaine jelly for some decrease in discomfort during disimpaction.
great review!
good
amazing
great review
good to know
Good recommendation on glycerin suppository 1 hour prior to disimpaction
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amazing
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Great review!
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mag citrate – lots of pain and cramps
of all of these I would say that PEG is likely the best choice
k
sometimes takes many agents to make BMs regular
I also start with PEG in the community since it has less side effects like abdominal cramping and gas.
I would also use PEG
forget the glycerin tip go straight to biscodyl supp.
Also fleet enema also helpful for overflow constipation related to opioid use
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agree
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pensar en constipacion
constipation its always loose in our minds
pensar en constipación y en su manejo
Important to manage constipation
🙂
peg lyte
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Methylnaltrexone (Relistor) is also an option.
i find if Peg 3350 is used daily it’s effect decreases
lactulose causes a lot of gas. Often it is 3rd line for my patients. PEG is much gentler.