On Call: Constipation & Bowel Regimen

Causes of Acute Constipation

General Postoperative Causes

  • Narcotic Pain Meds
  • General Anesthesia
  • General Inflammation (From Trauma or Infection)
  • Electrolyte Imbalance
  • Fluid Imbalance
  • Hyperglycemia or Hypoglycemia
  • Prolonged Inactivity

Ileus

Small Bowel Obstruction

Chronic Constipation & Large Bowel Obstruction

Management & Bowel Regimen

General Management

  • Consider Making the Patient NPO
  • Consider an Abdominal X-Ray to Evaluate Bowel Gas Pattern
  • Start/Increase Bowel Regimen
    • Avoid Using Laxative if Complete Bowel Obstruction is Suspected
    • Use of Laxatives for Partial Bowel Obstruction Not Definitive
  • Avoid Offending Agents (Opioids, Dopamine Antagonists, Anticholinergics)
  • Monitor Electrolytes
  • Consider placing an NG Tube
  • Ileus Prevention

Types Laxatives

  • Dietary Fiber
  • Laxatives
    • Bulk Forming
    • Osmotic
    • Stimulant
  • Stool Softeners
  • Enemas

Dosing

Generic Bowel Regimen

  • Start with Polyethylene Glycol (MiraLAX) Once Daily
  • Then: Add Senna 2-Tabs Twice Daily
    • Instead Use Colace if Stimulant Laxatives are Contraindicated (Recent Anastomosis)
  • Then: Magnesium Hydroxide (Milk of Magnesia)
    • Instead Use Lactulose if Magnesium Hydroxide Contraindicated (Renal Failure)
  • Then: Add Bisacodyl Suppository Daily
  • Then: Add Enema Daily