What is the care plan for a patient with acute constipation?

From the Guidelines

The care plan for a patient with acute constipation should begin with lifestyle modifications, including increased fluid intake and dietary fiber, and may involve the use of over-the-counter laxatives such as polyethylene glycol or bisacodyl, as recommended by the most recent guidelines 1.

Key Components of Care Plan

• Increased fluid intake (2-3 liters daily) to help soften stool and make it easier to pass
• Dietary fiber (25-30g daily) to help promote regular bowel movements
• Physical activity to help stimulate bowel movements
• Over-the-counter laxatives such as:
  • Osmotic laxatives like polyethylene glycol (MiraLAX, 17g in 8oz water daily)
  • Stimulant laxatives such as bisacodyl (5-10mg orally or 10mg rectally)
• Stool softeners like docusate sodium (100mg twice daily) to help prevent straining
• For severe cases, a glycerin suppository or sodium phosphate enema can provide rapid relief

Considerations for Opioid-Induced Constipation

• Peripherally acting mu-opioid receptor antagonists (PAMORAs) such as methylnaltrexone, naloxegol, or naldemedine may be effective in treating opioid-induced constipation 1
• Opioid rotation to fentanyl or methadone may be considered
• Enemas with sodium phosphate, saline, or tap water may be helpful, but should be used sparingly and with awareness of possible electrolyte abnormalities

Monitoring and Follow-up

• Patients should be monitored for signs of obstruction, such as severe pain, vomiting, or rectal bleeding
• If constipation persists beyond two weeks, medical evaluation is necessary to rule out underlying causes
• Patients should maintain a regular bathroom schedule, respond promptly to the urge to defecate, and consider keeping a food diary to identify trigger foods

Additional Recommendations

• Abdominal massage may be efficacious in reducing gastrointestinal symptoms and improving bowel efficiency, particularly in patients with concomitant neurogenic problems 1
• Suppositories and enemas are preferred first-line therapy when a digital rectal examination identifies a full rectum or fecal impaction 1

From the FDA Drug Label

USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days The care plan for a patient with acute constipation may include the use of polyethylene glycol (PO) to relieve constipation, as it can generally produce a bowel movement in 1 to 3 days 2.

• The patient should be instructed to take the medication as directed to help relieve constipation.
• It is essential to note that this medication is for occasional constipation, and the patient's condition should be monitored to determine the best course of treatment.

From the Research

Care Plan for Acute Constipation

The care plan for a patient with acute constipation involves a combination of non-pharmacological and pharmacological interventions. The following are some key components of the care plan:

• Assessment: A thorough assessment of the patient's medical history, physical examination, and laboratory tests to identify the underlying cause of constipation 3
• Non-pharmacological interventions: Increased fiber intake, adequate fluid intake, and regular physical activity can help alleviate constipation symptoms 4, 5
• Pharmacological interventions: Laxatives, such as bulk agents, osmotic agents, and stimulant laxatives, can be used to treat constipation 3, 6
• Dietary modifications: A high-fiber diet, including foods such as fruits, vegetables, and whole grains, can help promote regular bowel movements 4, 7
• Biofeedback therapy: Biofeedback therapy can be beneficial for patients with dyssynergic defecation, a type of constipation characterized by impaired coordination of the pelvic floor muscles 3

Treatment Options

The treatment options for acute constipation depend on the underlying cause and severity of symptoms. The following are some common treatment options:

• Fiber supplementation: Fiber supplements, such as psyllium and pectin, can help increase stool frequency and improve stool consistency 4
• Laxatives: Laxatives, such as sennosides and docusate, can be used to treat constipation, but should be used with caution and under medical supervision 6
• Stool softeners: Stool softeners, such as docusate, can help soften the stool and make it easier to pass 6
• Enemas and suppositories: Enemas and suppositories can be used to treat severe constipation, but should be used with caution and under medical supervision 6

Special Considerations

The following are some special considerations for patients with acute constipation:

• Pediatric patients: Fiber supplementation, such as glucomannan, can be beneficial for pediatric patients with constipation 7
• Geriatric patients: Geriatric patients may require closer monitoring and adjustment of treatment due to age-related changes in bowel function 3
• Patients with underlying medical conditions: Patients with underlying medical conditions, such as diabetes or neurological disorders, may require special consideration and adjustment of treatment 3