Bowels

Key points

  • Constipation (stools that are decreased in frequency and/or difficult to evacuate) is a common problem in palliative care patients, and is frequently multifactorial. Prevalence and severity of constipation increases as patients become more 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.

Assessment

  • 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.
  • 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

  • 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.

Prescribing guidance - Bowels

Constipation
Evidence based, free online prescribing guidance

See also Intestinal Obstruction, Diarrhoea, Haemorrhoids, Tenesmus

From: Palliative Care Adult Network Guidelines Plus


Evidence summary - Bowels

Constipation
Summarises the palliative care literature

From: CareSearch

Last updated 16 February 2017