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Palliative cancer care - constipation - Management
Overview of management
- Where possible alleviate contributing factors (e.g. inadequate diet, dehydration, having to use a bedpan, lack of privacy, anal fissure, painful haemorrhoids, or local tumour).
- Start treatment with a combination of a stimulant and a softening laxative.
- Titrate the dose of laxatives every few days to achieve comfortable defecation.
- High (off-licence) doses may be needed to achieve this, particularly for people taking opioid analgesics.
- Relieve faecal loading/impaction, if present. Hard impacted stools may need softening before a purgative effect is aimed for.
- When introducing an opioid (or other constipating drug) advise the person of the risks of constipation and prescribe a laxative to prevent constipation.
- If the response to laxatives is insufficient:
- Exclude obstruction.
- Consider adding in a macrogol, or a prokinetic drug such as metoclopramide, domperidone, or erythromycin.
- If neurological gut dysmotility is present, consider a weekly dose of sodium picosulfate.
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