What is the treatment for constipation lasting 10 days?

Treatment for Constipation Lasting 10 Days

For constipation lasting 10 days, polyethylene glycol (PEG) is the recommended first-line treatment due to its proven efficacy in increasing bowel movements and providing symptom relief. 1

Initial Assessment

• Rule out impaction, obstruction, and other treatable causes such as hypercalcemia, hypokalemia, hypothyroidism, and diabetes mellitus 1, 2
• Discontinue any non-essential constipating medications (antacids, anticholinergics, antiemetics) 1
• Check for possible overflow diarrhea which may indicate impaction 2

First-Line Treatment Approach

• Polyethylene glycol (PEG) - 17g mixed in 8 ounces of liquid once daily; produces bowel movement in 1-3 days 1, 3

  • Strong recommendation with moderate certainty of evidence 1
  • Increases complete spontaneous bowel movements by 2.9 per week compared to placebo 1
  • Side effects may include abdominal distension, loose stool, flatulence, and nausea 1

• Lifestyle modifications (implement alongside medication):

  • Increase fluid intake, particularly for those with low fluid intake 1, 2
  • Increase dietary fiber if fluid intake is adequate 1, 4
  • Encourage physical activity when appropriate 1, 2

Second-Line Treatments

If constipation persists after PEG treatment:

• Stimulant laxatives - Add bisacodyl 10-15mg, 2-3 times daily with a goal of one non-forced bowel movement every 1-2 days 1
• For impaction - Use glycerin suppositories or perform manual disimpaction if necessary 1, 2
• Additional options if constipation continues:
  • Rectal bisacodyl once daily 1
  • Lactulose 30-60mL daily 1
  • Magnesium hydroxide or magnesium citrate 1
  • Consider adding a prokinetic agent such as metoclopramide if gastroparesis is suspected 1

Fiber Supplementation Considerations

• Psyllium is the best-studied fiber supplement and can be used for mild constipation before or alongside PEG 1, 5, 6

  • Generally produces bowel movement in 12-72 hours 5
  • Most effective at doses >10g/day with treatment duration ≥4 weeks 6
  • May cause increased flatulence 1, 6

• Water-insoluble fibers (cellulose, hemicellulose) are more effective for constipation than water-soluble fibers (pectin, gums) 7

Special Considerations

• For opioid-induced constipation, consider methylnaltrexone 0.15mg/kg subcutaneously when laxatives are insufficient 1
• Avoid enemas in patients with neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis 2
• If constipation persists despite multiple interventions, reassess for cause and consider specialty referral 8

Treatment Algorithm

1. Start PEG 17g daily with increased fluid intake and physical activity
2. If no response within 3 days, add stimulant laxative (bisacodyl)
3. If still no response, check for impaction and consider glycerin suppository
4. For persistent constipation, add or switch to other laxatives (lactulose, magnesium preparations)
5. Consider specialty referral for constipation that fails to respond to the above measures 1, 8