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Palliative cancer care - constipation - Management
How should I treat faecal loading/impaction?
- Start treatment with a combination of a stimulant and softening laxative. This is likely to need to be continued once impaction has been cleared.
- When the response to initial treatment is insufficient or not fast enough:
- For high faecal impaction/loading (i.e. stool not present in the rectum), consider bowel washout with a macrogol.
- E.g. Movicol® 8 sachets dissolved in 1 Litre of water taken over 6 hours by mouth. Keep solution in a refrigerator during treatment. In heart failure limit to 2 sachets (250 mL) per hour.
- For low faecal impaction/loading (i.e. stool is in the rectum), consider:
- Using a suppository: bisacodyl for soft stools, glycerol alone or glycerol plus bisacodyl for hard stools.
- Using a mini-enema: docusate (softener and weak stimulant) or sodium citrate (osmotic).
- If the response is still insufficient:
- Consider using a sodium phosphate enema, or an arachis oil retention enema, placed high if the rectum is empty but the colon is full.
- For hard faeces it can be helpful to give the arachis oil enema overnight before giving a sodium phosphate (large volume) or sodium citrate (small volume) enema the next day.
- Enemas may need to be repeated several times to clear hard impacted faeces.
- If none of these measures provide relief, then manual evacuation (using a topical anaesthetic gel and sedative cover) should be considered.
Clarification / Additional information
- The aim of treatment is to achieve complete disimpaction, with the minimum of discomfort. This may require several days during which doses and combinations of laxatives are adjusted.
- Enemas should be administered by a district nurse or carer.
- For more information see Advantages/disadvantages of laxatives.
Basis for recommendation
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