Notes for: LaxativesLast edited [09/09/2015 09:45:55]
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)
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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.
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If treatment with prucalopride is not effective after 4 weeks, the woman should be re-examined and the benefit of continuing treatment reconsidered.
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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.
Notes for: Bowel Cleansing SolutionsLast edited [05/08/2013 16:25:42]
NPSA Rapid Response Review on Reducing risk of harm from oral bowel cleansing solutions (Feb 2009) notes that death and harm from electrolyte abnormalities, dehydration and serious gastro-intestinal problems have been reported following the inappropriate use of oral bowel cleansing solutions (Picolax®, CitraFleet® , Fleet Phospho-Soda®, Klean Prep®, Moviprep®) prior to surgery and/or investigative procedures. Frail and debilitated elderly patients, children and those with contraindications are particularly at risk from these treatments. Recommendations include:
- A clinical assessment is undertaken by the clinician authorising the surgery or investigative procedure (including GPs using the direct access route) to ensure that there is no contraindication (eg clinical condition such as diverticulitis) or risks (eg concurrent medication such as diuretics) from the use of a bowel cleansing solution.
- Use of a bowel cleansing solution is authorised by the clinician at the same time as the surgery or investigative procedure. This may be done by using the same form.
- The clinician requesting the surgery or procedure and authorising the use of a bowel cleansing solution is responsible for ensuring that an explanation on the safe use of the product is provided to the patient or carer.
- A safe system exists that involves an authorised clinical professional in the supply of the medicine and written information (including named contact) for each patient.