Undifferentiated constipation in palliative care

For information on general management of constipation and laxatives used in palliative care, see Management of constipation in palliative care.

A variety of laxatives can be used for the initial management of constipation in patients with palliative care needs, although there is a lack of evidence for their use. Use:

1docusate+senna 50+8 mg 1 or 2 tablets orally, once daily at night or twice daily docusate + senna

OR

1macrogol 3350 orally1; for example: macrogol

Movicol (with electrolytes) 13.12 g per sachet, use 1 sachet (mix each sachet with 125 mL of water), up to 2 to 3 sachets daily

OR

OsmoLax (without electrolytes) 17 g per measuring scoop, use 1 level scoop (mix each scoop with 240 mL of water), up to 2 scoops daily

OR

1senna+dried fruit block 10 g orally, daily2 senna

OR

1sodium picosulfate 7.5 mg/mL liquid 5 mg (10 drops) orally, at night. Increase dose as tolerated up to 10 mg (20 drops) at night. sodium picosulfate

Regular frequent questioning about constipation is important. If the initial laxative is ineffective, an additional laxative may be required, depending on the kind of stool the patient last produced—see Constipation with hard faeces in the rectum in palliative care or Constipation with soft faeces in the rectum in palliative care. Also consider reassessing the cause of constipation.

1 Various preparations of macrogol 3350 (with or without electrolytes) are available; dose according to product information. Advise patients that they may sip the macrogol 3350 solution over several hours if the volume appears to be too much to drink all at once.Return
2 Various brands of senna+dried fruit are available (eg Nulax).Return