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  • Palliative2 Constipation Algorithm

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    Ruth R
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    This document provides an algorithm for constipation management. It begins with an assessment of the patient's normal bowel habits, current performance, stool frequency and consistency, and ease of evacuation. For patients without obstruction, it determines if constipation or irritable bowel syndrome is present and provides treatment options. These include osmotic laxatives, sennosides-based protocols, and rectal measures. For non-responders it evaluates causes like hypomobility and considers prokinetic agents or switching laxatives. It also addresses opioid-induced constipation and when to consult palliative care.

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    This document provides an algorithm for constipation management. It begins with an assessment of the patient's normal bowel habits, current performance, stool frequency and consistency, and ease of evacuation. For patients without obstruction, it determines if constipation or irritable bowel syndrome is present and provides treatment options. These include osmotic laxatives, sennosides-based protocols, and rectal measures. For non-responders it evaluates causes like hypomobility and considers prokinetic agents or switching laxatives. It also addresses opioid-induced constipation and when to consult palliative care.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    8 views1 page

    Palliative2 Constipation Algorithm

    Uploaded by

    Ruth R
    This document provides an algorithm for constipation management. It begins with an assessment of the patient's normal bowel habits, current performance, stool frequency and consistency, and ease of evacuation. For patients without obstruction, it determines if constipation or irritable bowel syndrome is present and provides treatment options. These include osmotic laxatives, sennosides-based protocols, and rectal measures. For non-responders it evaluates causes like hypomobility and considers prokinetic agents or switching laxatives. It also addresses opioid-induced constipation and when to consult palliative care.

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    © All Rights Reserved
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    of 1

    Constipation Management Algorithm

    Assessment (A1) BM bowel movement


    Hyperlinks indicate
    • Normal bowel habit WBC white blood cell count
    additional information • Current bowel performance (A3) Plt platelet count
    available in guideline o Stool frequency
    sections above: o Stool consistency
    A = Assessment o Ease of evacuation Manage according to
    M = Management FPON guideline,
    Medical Management
    Yes of Malignant Bowel
    Obstructed Obstruction
    bowel?

    No
    PREVENTION No Yes TREATMENT
    needed needed (M2)
    Constipation?

    1. Rectum empty; OR
    No Yes 2. Contraindications to rectal
    Irritable bowel
    intervention:
    syndrome?
    • neutropenia (WBC <0.5) OR
    • thrombocytopenia (Plt <20)

    Osmotic Laxative Sennosides-­based Protocol (M4+5)


    No Rectal Measures (M3)
    (M4+5) success • Escalating doses until satisfactory BM
    • Manual disimpaction
    • Lactulose or sorbitol • Maximum senna dose 36 mg tid
    (if indicated)
    • Polyethylene glycol • Add rectal measures at any time
    • Glycerin supp
    • Escalating doses until if indicated and no
    • Bisacodyl supp
    satisfactory BM contraindications (M3)
    • Microlax enema
    • Fleet enema*
    No • Warm water enema
    success
    • Oil enema
    followed by
    Assess cause
    Sennosides-­based Protocol
    Hypomobility
    (e.g., ascites, Opioid-­induced (M9)
    autonomic neuropathy,
    abdominal cancer)
    Consider switching to less
    constipating opioid (e.g., fentanyl)

    Consider prokinetic agent


    (e.g., domperidone, metoclopramide)
    Add or switch to
    osmotic laxative

    Add or switch to
    osmotic laxative Consider methylnaltrexone (or naloxegol)
    No success

    Palliative Care Consult *Contraindicated in patients with renal failure.

    BCGuidelines.ca: Palliative Care for the Patient with Incurable Cancer or Advanced Disease Part 2: Pain and Symptom Management – Constipation (2017)

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