Warning

Audience

  • Highland HSCP
  • Secondary Care

Emergency admission of adults with acute constipation

Beware: constipation, a common symptom, but it sometimes heralds a surgical emergency.  

Click here for PDF version of flowchart

 

Older adult inpatient management

General aim should be to move bowels three times per week. If not moved after 2 days in hospital, assessment for constipation required.

Consider the following throughout admission:

Non-pharmacological

  • Dietary advice
  • Prunes and porridge
  • Fruit/ Fruit juice (caution in diabetes)
  • Dietary fibre intake (menu choices)
  • Aiming 1.5 to 2 litres of fluid daily
  • Hot, decaffeinated drinks
  • Maintain activity as able

Best position


Consider timing: 30 minutes after breakfast and hot drink
Try to avoid delay when the urge develops, and avoid rushing the person

Undertake medication review

Identify constipating medicines including:

  • Aluminium containing antacids
  • Antidiarrhoeals
  • Iron and calcium supplements
  • Opioid analgesics
  • Calcium channel blockers: diltiazem
  • Antimuscarinics: oxybutynin, amitriptyline, imipramine
  • Antipsychotics: amisulpride, chlorpromazine
  • Gabapentin/pregabalin, carbamazepine, etc

Medical review including PR

Consider laxatives:

  • FIRST LINE: Laxido©  (osmotic laxative)
    Usual starting dose of 1 sachet twice daily
  • SECOND LINE: docusate (softener) or sennosides (stimulant) and treat as per usual

Suppositories/enemas

Where stools are soft but difficult to pass (or no enteral route available) use bisacodyl suppositories 10mg daily and/or glycerol suppositories 4g daily

For hard stools use sodium phosphate retention enema or Micralax Micro-enema in morning

Printable poster

Ward Bowel Chart

Editorial Information

Last reviewed: 27/10/2022

Next review date: 31/10/2025

Author(s): Medicine for the Elderly and Department of General Surgery.

Version: 2

Approved By: TAMSG of the ADTC

Reviewer name(s): Dr D Gray, Assoc Specialist, Medicine for the Elderly, K Walker, General Surgeon, A Warren, Medicine for the Elderly Pharmacist.

Document Id: TAM534 & TAM4462

Related resources

Further resources for Healthcare Professionals 

References

Patient information