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Constipation Algorithm

This algorithm summarizes guidelines for managing constipation, especially in elderly patients. It provides guidance on determining stool consistency and faecal loading to identify appropriate treatment approaches. These may include increasing fibre, fluid, and mobility; using osmotic laxatives, faecal softeners, or stimulant laxatives; or administering suppositories or enemas. It also outlines factors to consider in the patient's history and examination and criteria for referral. The goal is to establish regular evacuation through both short-term and long-term treatment regimes.

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1K views1 page

Constipation Algorithm

This algorithm summarizes guidelines for managing constipation, especially in elderly patients. It provides guidance on determining stool consistency and faecal loading to identify appropriate treatment approaches. These may include increasing fibre, fluid, and mobility; using osmotic laxatives, faecal softeners, or stimulant laxatives; or administering suppositories or enemas. It also outlines factors to consider in the patient's history and examination and criteria for referral. The goal is to establish regular evacuation through both short-term and long-term treatment regimes.

Uploaded by

IYERBK
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CONSTIPATION & FAECAL INCONTINENCE ALGORITHM

NB: This algorithm summarises the guidelines for management of constipation, especially in the elderly.

FAECAL LOADING?
STOOL CONSISTENCY? 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

Too Hard Too Soft With hard stool With soft/


or “overflow” formed stool

•Increase diet fibre •Loperamide Regular/daily Trial of


(fit/mobile patients only) (titrate dose suppository/enema*: short-term
•Increase fluid intake carefully) •Glycerine suppos oral senna
•Increase mobility if necessary ↓ or
•Osmotic laxative-lactulose add: •Bisacodyl suppos bisacodyl
if necessary add •Codeine (or ‘microlax’)
•Faecal softener –docosate phosphate ↓
•Enema (Fleet oil
NB. Use bulk laxatives (eg &/or phosphate) *
psyllium) only if fluid intake
high – can cause constipation
Commence regular oral regime

Factors associated with Appropriate history REFERRAL if required


constipation/faecal incontinence •Past bowel habit For enema (or suppository
•Sphincter weakness •Awareness of call to not able to be managed by
•Anal sensory loss stool patient):
•Immobility •Stool consistency •Contact GP or a Nurse
•Diet/dehydration •Laxative use/ medication •Prescribe enema or
•Faecal loading •Mobility suppository
(see management above) •Diet •Complete the
•Medication (eg opiate, tricyclic) nursing medication sheet
•Slow colonic transit (eg opiates) Examination to enable follow up.
•Loss of cognitive awareness •Abdominal exam NB. The standard regime &
•Laxative abuse •Anorectal exam protocol may have to be followed
•Bulk laxatives (can constipate if •Digital rectal exam by any attending clinician in the
fluid intake insufficient) •Cognitive assessment times ahead.

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