• Formulary factsheet: Proton Pump Inhibitors in children
• National clinical constipation pathway for primary care for children 2023
  

1. Identify cause of constipation and treat underlying cause if possible. General management includes increased dietary fibre, ensure adequate fluid intake, increase mobility, reviewing medication and encouraging regular toileting habits (after meals, good position).

2. Acute constipation is generally managed by a stimulant laxative. Chronic constipation may require a bulk forming or osmotic laxative - if this is unsuccessful add in a stimulant laxative. If chronic constipation has not resolved, substitute treatment with low dose Movicol^®.

3. Methylnaltrexone is indicated for the treatment of opioid-induced constipation in palliative care patients where optimal laxative therapy has not been sufficient. It is seen as an alternative to rectal intervention in a small selected group of patients, and should only be used after discussion and assessment of the patient by a palliative care specialist (in consultation with a Palliative Care Consultant). Any full assessment of opioid-induced constipation would ideally include a rectal examination.

4. NICE guidance for the treatment of chronic constipation in women (Dec 2010)

1. Prucalopride is recommended as an option for the treatment of chronic constipation only in women for whom treatment with at least two laxatives from different classes, at the highest tolerated recommended doses for at least 6 months, has failed to provide adequate relief and invasive treatment for constipation is being considered.
2. If treatment with prucalopride is not effective after 4 weeks, the woman should be re-examined and the benefit of continuing treatment reconsidered.
3. Prucalopride should only be prescribed by a clinician with experience of treating chronic constipation, who has carefully reviewed the woman’s previous courses of laxative treatments specified in (1) above.

1. The use of co-danthramer and co-danthrusate is restricted by its license to the treatment of constipation in terminally ill patients only.

2. Most terminally ill patients require both a softening agent and a stimulant laxative, for example co-danthramer (or a less expensive agent such as lactulose) and senna.