Management

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Many different laxatives are available. A common first step is to increase the fiber content of diet or enteral feed. Enteral feeds were originally low residue, i.e.

contained no fiber, but a variety of fiber-containing feeds are now available. The fiber is usually in a single form (e.g. methylcellulose). As noted above, there is no evidence that these prevent or control constipation. In some patients the addition of fiber increases wind, bloating, abdominal distension, and discomfort.

A management plan for bowel treatment in unconscious patients who are unable to swallow is shown in Fig 1. Management of conscious patients is individualized depending on their usual bowel habit, eating, and symptoms. When patients have a daily bowel habit, are confined to bed, and have not defecated for 2 days, docusate sodium tablets (120-240 mg) are given as a fecal softener. More prolonged constipation is treated with a stepwise approach, moving to the next step if the previous treatment is ineffective (TâbJeJ).

Fig. 1 Bowel management and treatment of constipation in unconscious patients needing intensive care.

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Table 2 Progressive steps in the treatment of constipation in conscious patients

Cisapride promotes gastric emptying and absorption of nasogastric feeds. It also increases stool frequency in patients with chronic constipation. Diarrhea is a fairly common side-effect. Whether cisapride reduces the frequency of constipation in ICU patients has still to be confirmed.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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