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Primary Care Constipation Guidelines: Version 1.1 - December 2016
Primary Care Constipation Guidelines: Version 1.1 - December 2016
Guidelines
Version 1.1 – December 2016
VERSION CONTROL
Version Date Amendments made
Version 1 November
New guideline
2016
Version 1.1 December Bisacodyl removed from the children’s pathway and
2016 replaced with sodium picosulphate. Approved at
LMMG. Minor amendments to formatting.
Contents
1. Management of constipation in adults: acute and chronic treatment pathways
Bibliography: 1) National Institute for Health and Clinical Excellence (NICE), "Clinical Knowledge Summary: Constipation," NICE, Manchester, 2015. 2) National
Institute for Health and Clinical Excellence (NICE), ”NICE technology appraisal 211: Prucalopride for the treatment of chronic constipation in women”, NICE,
Manchester, 2010. 3) National Institute for Health and Clinical Excellence (NICE), “NICE Technology appraisal 318: Lubiprostone for treating chronic idiopathic
constipation” NICE , Manchester, 2014. 4) Ford et al, "Laxatives for chronic constipation in adults," The British Medical Journal, vol. 345, no. e6168, 2012.
Management of constipation in adult patients: opioid-induced constipation pathway
Review current medication and identify Box 1: Medication commonly prescribed Tricyclic antidepressants
potential cause of constipation. Review that may cause constipation: Verapamil
need for opioid-based medication. Opioids Clozapine
Discontinue if no-longer indicated – see Calcium channel blockers (note: It is essential that constipation is actively
box 1 treated in patient receiving clozapine (fatalities
Diuretics reported).
Iron preparations
Anti-cholinergic drugs
Offer dietary and lifestyle
advice to all patients - see Box 2: Lifestyle and dietary advice: • Adequate fluid intake is important. Although
Box 2 there is no evidence that increased fluid
• Defecation should be unhurried intake will improve symptoms in those that
• Attempt defecation first thing in the morning are already well hydrated
or 30minutes after a meal • Natural laxatives, such as fruit and fruit
• Respond immediately to the call to toilet juices, high in sorbitol can be recommended.
• Consideration should be given to those with Dried fruit has a higher sorbitol content (5 –
mobility issues 10times higher)
Consider commencing an osmotic laxative AND a stimulant • Diet should be balanced and contain whole
laxative (do not commence a bulk forming laxative) - see box 3
grains, fruits and vegetables.
• Fibre intake should be increased gradually
The dose of laxatives should be gradually titrated upwards (or and maintained:
downwards) to produce one or two soft stools per day. • Adults should aim to consume 18 –
30gram of fibre per day.
• Effects may take up to four weeks.
Bibliography: 1) National Institute for Health and Clinical Excellence (NICE), "Clinical Knowledge Summary: Constipation," NICE, Manchester, 2015. 2) National
Institute for Health and Clinical Excellence (NICE), ”NICE technology appraisal 345: Naloxegol for treating opioid-induced constipation”, NICE, Manchester,
2015.
Management of constipation in children: NICE Clinical Guideline 99
Assess the patient for faecal
impaction
If stools are hard, add another Laxido Paediatric – by mouth (refer parent/carer to
laxative such as lactulose or PIL for instructions on dilution):
docusate. Child under 1 year: ½–1 sachet daily
Bibliography: National Institute for Health and Clinical Excellence (NICE), ”NICE Clinical Guideline 99: Constipation in Children and Young People NICE,
Manchester, 2015. Royal Pharmaceutical Society, British National Formulary, vol. 70, London: Pharmaceutical Press, 2016.