Can I administer lactulose or a soap suds enema to a post-surgical patient with constipation, last bowel movement 3-4 days ago, and currently taking Tums (calcium carbonate) for acid reflux?

Management of Constipation in Post-Surgical Patient

Yes, lactulose can be administered to this post-surgical patient who has not had a bowel movement in 3-4 days, especially since she is taking opioids (oxycodone) which likely contributes to her constipation. 1, 2

Assessment of Current Situation

• Patient reports no bowel movement for 3-4 days, which meets criteria for constipation 1
• Patient is able to pass gas, indicating absence of complete obstruction 1
• Patient is on oxycodone, which is known to cause constipation 1
• Patient is also taking Tums (calcium carbonate), which can contribute to constipation 1

Recommended Intervention

• Administer lactulose 15-30 mL orally as an initial dose 1, 2
• Standard adult dosing for constipation is 15-30 mL (10-20g) daily, which can be increased to 30-45 mL if needed 2
• Monitor for bowel movement within 24-48 hours after administration 1

Rationale for Lactulose

• Lactulose is an FDA-approved osmotic laxative that exerts its effect by drawing water into the intestine to hydrate and soften stool 1
• It promotes peristalsis in the colon, which is particularly beneficial in opioid-induced constipation 1
• Clinical studies show lactulose is associated with increased bowel movement frequency compared to placebo 1, 3
• Lactulose has been shown to decrease the need for enemas and reduce fecal impactions 1, 3

Alternative Options

• A soap suds enema could also be considered, particularly if lactulose does not produce results within 24-48 hours 1
• Stimulant laxatives like bisacodyl (10-15 mg daily) are also recommended for opioid-induced constipation 1
• Polyethylene glycol (PEG) is another effective option and has shown superior results to lactulose in some studies 4

Precautions and Side Effects

• Monitor for bloating and flatulence, which are common side effects of lactulose 1
• Start with a lower dose if the patient has sensitive bowels or is elderly 1
• Ensure adequate fluid intake while administering lactulose 1
• If diarrhea occurs, reduce the dose immediately 2

Follow-up Care

• If no bowel movement occurs within 24-48 hours after lactulose administration, reassess for:
  • Potential bowel obstruction 1
  • Need for additional interventions such as stimulant laxatives or enemas 1
• Consider prophylactic bowel regimen for ongoing opioid use, as patients do not develop tolerance to opioid-induced constipation 1

Special Considerations for Post-Surgical Patients

• Ensure the patient is adequately hydrated 1
• Consider the impact of limited mobility on bowel function 5
• Monitor for any signs of post-surgical complications that might affect bowel function 1