Constipation with an empty 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 an empty rectum in a patient who has suspected constipation, give a stimulant enema initially, followed by oral laxatives. For example, use:
1bisacodyl 10 mg/5 mL enema rectally, as a single dose bisacodyl
OR
1sorbitol+sodium citrate+sodium lauryl sulfoacetate enema rectally, as a single dose1. sorbitol + sodium citrate + sodium lauryl sulfoacetate enema
Follow 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 regimen is ineffective, consider using sodium amidotrizoate+amidotrizoate meglumine (Gastrografin), which may be available from a hospitalHeng, 2018.
After constipation resolves, review the patient’s regular laxative regimen and modify if necessary, or consider starting a regular regimen to prevent recurrence.