From the Guidelines
Constipation after treatment for C. diff can be effectively managed by increasing fluid intake, consuming fiber-rich foods, and using over-the-counter laxatives, with the goal of restoring normal gut flora and bowel movements. To manage constipation after C. diff treatment, it is essential to understand the underlying mechanisms of how antibiotics disrupt the normal gut flora, as discussed in the study by 1. The use of antibiotics, such as vancomycin or fidaxomicin, can alter the gut microbial community structure and function, leading to decreased diversity of the gastrointestinal microflora and favoring the growth of C. difficile. Some key strategies to manage constipation include:
- Increasing fluid intake to at least 8 glasses of water daily
- Consuming more fiber-rich foods like fruits, vegetables, and whole grains
- Using over-the-counter options such as osmotic laxatives like polyethylene glycol (Miralax, 17g dissolved in 8oz water daily) or stool softeners like docusate sodium (Colace, 100mg twice daily)
- Engaging in regular physical activity, even gentle walking for 20-30 minutes daily, to help stimulate bowel movements
- Avoiding medications that may worsen constipation, such as certain pain relievers, antacids containing calcium or aluminum, and some antidepressants It is crucial to note that the restoration of microbial diversity following treatment is an important factor determining the success of fecal transplant, as mentioned in the study by 1. If constipation persists beyond 1-2 weeks despite these measures, it is essential to consult a healthcare provider to rule out recurrent C. diff infection or other complications.
From the Research
Constipation after Treatment for C. Diff
- Constipation is a common gastrointestinal motility disorder that can be chronic and negatively affect patients' daily lives 2.
- There is limited data on the effectiveness of nonpharmacologic modalities, such as increased exercise or fluid intake and bowel habit training, in treating constipation 2.
- Some studies suggest that psyllium, polyethylene glycol, and lactulose may be beneficial in treating constipation, but the use of other agents is not supported by strong clinical evidence 2, 3.
- Psyllium has been shown to be superior to docusate sodium in softening stools and increasing stool water content in patients with chronic idiopathic constipation 4.
Treatment Options
- Polyethylene glycol has been shown to be effective and safe in several rigorous trials with durations of more than one year 3.
- New drugs, such as prucalopride, lubiprostone, and linaclotide, have been shown to be effective and safe in well-designed and rigorous studies 3.
- Biofeedback and behavioral therapies can be effective, but should be reserved for selected patients after proper diagnostic evaluation 3.
C. Diff Infection
- Clostridium difficile infection is a common hospital-acquired infection that can cause a range of symptoms, from asymptomatic carrier status to life-threatening colitis 5.
- The use of laxatives, such as docusate, senna, and polyethylene glycol 3350, is common among hospitalized adults undergoing C. difficile testing 6.
- Improving diagnostic stewardship around C. difficile testing, particularly in surgical and ICU patients, is a significant opportunity and priority for quality improvement 6.