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Palliative cancer care - constipation - Management
What should I do if the response to laxatives is insufficient?
- Check that the dose of stimulant and softening laxative has been adequately titrated.
- Adjust the dose of stimulant to produce defecation without colic.
- Adjust the dose of softener to produce a comfortable stool.
- Higher and more frequent doses than specified by the product licence may be needed.
- The laxative dose also needs to increase with increases in opioid dose.
- Consider adding in a macrogol, or a prokinetic agent such as metoclopramide, domperidone, or erythromycin 250–500 mg four times a day (off-licence use) — exclude obstruction before use.
- Consider whether additional short-term treatment for faecal loading/impaction is needed.
- If passing a stool is painful, exclude (or manage) anal fissure, painful haemorrhoids, or local tumour.
- If neurological gut dysmotility is present, consider a weekly dose of sodium picosulfate.
- Seek specialist advice if constipation still persists despite these measures.
In depth
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