From the Guidelines
To treat constipation in pancreatitis, start with gentle interventions like increasing fluid intake and gradually adding soluble fiber to your diet, and consider using psyllium as a first-line fiber supplement, as recommended by the American Gastroenterological Association 1. When managing constipation in pancreatitis, it's essential to prioritize gentle and effective interventions to minimize the risk of exacerbating pancreatic inflammation or causing discomfort.
- Increasing fluid intake to at least 8-10 glasses of water daily is crucial to help soften stool and make bowel movements less painful.
- Gradually adding soluble fiber to your diet through foods like oatmeal, bananas, and applesauce can help regulate bowel movements.
- Psyllium, a fiber supplement, appears to be effective in managing constipation, with limited and uncertain data on bran and inulin 1.
- Adequate hydration should be encouraged with the use of fiber to minimize the risk of side effects like flatulence. Some studies suggest that stool softeners like docusate sodium (Colace) at 100 mg twice daily can help make bowel movements less painful, while others recommend avoiding stimulant laxatives like bisacodyl or senna, which can be too harsh during pancreatitis 1.
- For more persistent constipation, osmotic laxatives like polyethylene glycol (MiraLAX) at 17 grams mixed in 8 ounces of water once daily are generally safe.
- Gentle physical activity like short walks can also stimulate bowel function if your condition allows. It's essential to manage constipation carefully in pancreatitis, as straining during bowel movements can increase abdominal pain and potentially worsen pancreatic inflammation, and always consult your healthcare provider before starting any medication, as they may need to adjust recommendations based on your specific condition, especially if you have severe pancreatitis or are hospitalized 1.
From the Research
Treatment of Constipation in Pancreatitis
- Constipation is not directly addressed in the provided studies, however, the management of pancreatitis and its symptoms can be related to the treatment of constipation.
- In patients with pancreatitis, dietary restrictions and enzyme replacement are recommended to address digestive issues 2.
- A trial of pancreatic enzymes can control symptoms in up to 50% of patients with chronic pancreatitis, which may indirectly help with constipation 3.
- Enteral nutrition is recommended to prevent infectious complications in severe acute pancreatitis, and nasojejunal tube feeding is considered the current standard of care 4.
- However, recent clinical studies have shown that tube feeding into the stomach is safe and well tolerated in the vast majority of patients with acute pancreatitis, which may be beneficial for patients with constipation 4.
Management of Pancreatitis
- Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics or nonsteroidal anti-inflammatories 2, 5.
- Patients with chronic disease and symptoms require further care to address digestive issues and the possible development of diabetes 2.
- The first line of therapy for chronic pancreatitis consists of advice to discontinue use of alcohol and smoking, and taking analgesic agents 3.
- Patients with pancreatic ductal obstruction may benefit from ductal drainage via endoscopic retrograde cholangiopancreatography (ERCP) or surgical drainage procedures 3.