Bowel issues need to be addressed

Constipation is a frequent complaint in the general community, and more common in palliative care patients. Opioid induced constipation should be considered during the assessment of constipation.

Key points

  • Constipation is a common problem in palliative care patients and is frequently multifactorial. Prevalence and severity of constipation increases as patients become more functionally dependent.
  • Symptoms should be assessed in relation to the person’s previous bowel habit.
  • The goal of management is prevention. Always ask about the symptom and manage pre-emptively.
  • Failure to manage constipation can lead to reduced adherence to medications, avoidable admissions, and is very distressing.


  • Always consider the possibility of bowel obstruction - especially in high risk patients (ovarian or bowel cancer, or those with peritoneal disease). They may present with symptoms of incomplete or intermittent obstruction.
  • The main role for an abdominal x-ray (AXR) is to exclude obstruction.
  • Faecal impaction may present with spurious diarrhoea, called 'overflow' diarrhoea.
  • Rectal examination should include an assessment of pelvic floor and sphincter functioning, checking for anal pathology, and looking for sources of pain on defecation.
  • Exclude metabolic causes eg, hypothyroidism, hypercalcemia.
  • Many medicines contribute to constipation. Review the drug chart. Some of the medications associated with constipation include opioids, serotonin (5HT3) blocking antiemetics like ondansetron, anticholinergics, calcium and iron tablets.
  • Assess hydration.

Approach to management

  • The person will generally require the use of aperients to manage constipation
  • Patient education.
  • Address any reversible contributors including pain, fluid intake, mobility and activity levels, toileting arrangements.
  • Reduce polypharmacy, and select less constipating opioids where appropriate.

Last updated 24 August 2021