CONSTIPATION & FAECAL INCONTINENCE ALGORITHM
NB: This algorithm summarises the guidelines for management of constipation, especially in the elderly.
Too Soft Too Hard
• Increase diet fibre (fit/mobile patients only) • Increase fluid intake • Increase mobility • Osmotic laxative-lactulose if necessary add • Faecal softener –docosate NB. Use bulk laxatives (eg psyllium) only if fluid intake high – can cause constipation
• Loperamide (titrate dose carefully)
if necessary add: • Codeine phosphate
FAECAL LOADING? with infrequent or unpredictable emptying (or no motion for 3 days, or “overflow”) NB This is a short term regime until regular evacuation is established –commence oral regime concurrently
Trial of short-term oral senna or bisacodyl
With soft/ formed stool
With hard stool or “overflow”
Regular/daily suppository/enema*: • Glycerine suppos
↓ • Bisacodyl suppos (or ‘microlax’)
↓ • Enema (Fleet oil &/or phosphate) *
Appropriate history
• Past bowel habit • Awareness of call to stool • Stool consistency • Laxative use/ medication • Mobility • Diet Examination • Abdominal exam • Anorectal exam • Digital rectal exam • Cognitive assessment
REFERRAL if required
For enema (or suppository not able to be managed by patient):
• Contact GP or a Nurse • Prescribe enema or suppository • Complete the nursing medication sheet
to enable follow up. NB. The standard regime & protocol may have to be followedby any attending clinician in thetimes ahead.
STOOL CONSISTENCY?
Commence regular oral regime
Factors associated with constipation/faecal incontinence
• Sphincter weakness • Anal sensory loss • Immobility • Diet/dehydration • Faecal loading (see management above) • Medication (eg opiate, tricyclic) • Slow colonic transit (eg opiates) • Loss of cognitive awareness • Laxative abuse • Bulk laxatives (can constipate if fluid intake insufficient)