The aim of treatment of uncomplicated constipation is to restore the patient to a pattern of defecation that relieves symptoms.
If diarrhea occurs during an adequate constipation treatment (non-drug measures and laxatives), the patient should be reassessed (including rectal examination) to exclude fecal impaction and intestinal obstruction.
Laxatives should be stopped for 24 hours and then restarted at one-half to three-quarters of the original dose.
Treatment depends on whether the feces are soft or hard:
- If the feces are soft a bisacodyl
suppository (10-20 mg) should be given, followed by a saline enema 2 hours later.
- If the feces are hard, an arachis oil
enema should be given in the late evening and retained overnight, followed by a bisacodyl
suppository (10 - 20 mg) in the morning and a saline enema.
If spontaneous defecation does not occur, the feces may have to be removed by digital manipulation. This procedure requires premedication with a benzodiazepine (e.g. lorazepam
2 mg by mouth or by intravenous injection; or midazolam
2 mg by mouth or by subcutaneous injection).
World Health Organization. Symptom relief in terminal illness. 1998. Internet. Accessed on March 5, 2019. Available at https://apps.who.int/iris/bitstream/handle/10665/42121/9241545070_eng.pdf;jsessionid=F4AC2B1F173EF2386B4AE7502105C4A3?sequence=1