Constipation with hard faeces in the rectum in palliative care
For information on general management of constipation and laxatives used in palliative care, see Management of constipation in palliative care.
If rectal examination reveals constipation is due to hard faeces in the rectum, initially use both a stool softening and a stimulant laxative suppository to start emptying the rectum. For example, use:
bisacodyl 10 mg suppository rectally, as a single dose bisacodyl
PLUS
glycerol 2.8 g suppository rectally, as a single dose. glycerol
Enemas can be ineffective because they may not be retained in the rectum for long enough to have an effect.
Follow initial therapy with an oral regimen; for example, use:
docusate 240 mg orally, at night docusate
PLUS
bisacodyl 10 mg orally, at night, increasing up to 10 mg twice daily. bisacodyl
If the above therapy is ineffective, seek specialist advice.
After constipation resolves, review the patient’s regular laxative regimen and modify if necessary, or consider starting a regular regimen to prevent recurrence.