RISK FACTORS :
β’ Extremes of life (very young and very old)
β’ Neurosis
β’ Polypharmacy
β’ Sedentary life style or condition
β’ Diet and fluid intake
GENERAL MEASURES :
β’ Attempt to eliminate medications that may cause or worsen constipation
β’ Increase fluid intake
β’ Modify diet
β’ Enemas if other methods fail
DIET :
β’ If no anatomic abnormalities, increase fiber to approximately 15 gm/day (bran, fruit, green vegetables, and
whole grain cereals and breads)
β’ Encourage liberal intake of fluids
DRUG(S) OF CHOICE :
. Hydrophilic colloids (bulk-forming agents; not really drugs)
. Psyllium (Konsyl, Metamucil, Perdiem)
. Methylcellulose (Citrucel)
. Polycarbophil (Mitrolan, FiberCon)
. Osmotic laxatives - appropriate for short-term use. The usual dose is 15 mL to 30 mL once or twice a day.
. Milk of magnesia 15-30 mL bid
. Magnesium citrate 15-30 mL bid
. Phosphate of soda 15-30 mL bid
. Lactulose (Chronulac) 15-30 mL bid
. Sorbitol 15-30 mL bid
. Alumina-magnesium (Maalox, Mylanta)
. Polyethylene glycol (MiraLax) 17 g in 8 oz of water q day
. Stool softeners
. Docusate sodium (Colace) 100 mg bid
CONTRAINDICATIONS:
. Any impediment to bowel transit, such as an obstructing lesion or ileus. Osmotic laxatives may result in
overdistension or bowel perforation
. Any acute intra-abdominal inflammatory condition
. Renal and heart failure are relative contraindications
ALTERNATIVE DRUGS :
1. Lubricants (e.g., mineral oil) are unpalatable to many patients, subject to leakage, and impose the risk of aspiration
2. Emollient suppositories are useful, if at all, in allaying anorectal soreness
3. Irritant cathartics (stimulants) :
. Ricinoleic acid or castor oil (Neoloid); 30-60 mL/day
. Phenolphthalein (Ex-Lax, Modane)
. Bisacodyl (Dulcolax); 2-3 tabs swallowed whole or 1 suppository bid
4. Motor and secretory properties :
. Anthraquinones: senna (Senokot); 1-2 cap or 15-30 mL qhs
5. Enemas (avoid soap suds - may lead to colitis)
. Sodium phosphate (Fleet enema)
6. Suppositories :
. Osmotic: sodium phosphate
. Lubricant: glycerin
. Stimulatory: bisacodyl
7. Prokinetic agents
PATIENT MONITORING : What seems to be simple, functional constipation, if it persists, should be further investigated for a possible organic cause
PREVENTION/AVOIDANCE : Because for some patients a tendency to constipation is habitual, instruction in proper diet, bowel training, and use of bulk-forming supplements must be reinforced
POSSIBLE COMPLICATIONS :
β’ Volvulus
β’ Cancer risk
β’ Acquired megacolon: in severe, long-standing cases
β’ Cathartic colon: repeated laxative abuse
β’ Fluid and electrolyte depletion: laxative abuse
β’ Rectal ulceration (stercoral ulcer) related to recurrent fecal impaction
β’ Anal fissures
EXPECTED COURSE/PROGNOSIS :
Constipation that is only occasional, brief, and responsive to simple measures is harmless. That which is
habitual can be a lifelong nuisance.
PATIENT EDUCATION
β’ Define constipation and normal variations
β’ Occasional mild constipation is normal
β’ Instruction in consistent bowel training i.e., allowing adequate time for bowel evacuation in a quiet, unhurried environment; instruction in facilitating posture on commode, e.g., thighs fl exed toward abdomen
β’ Parents sometimes need more treatment/advice than the constipated child