Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Constipation in Palliative Care
Michael Morcos, Clinical Pharmacist, Ward MM
The documented prevalence of constipation in palliative care is between 18% and 90%. It is the third most common symptom experienced in palliative care after pain and anorexia. It can cause significant suffering and affect quality of life. Hence, it is important to anticipate, monitor and effectively manage constipation.
There are many factors that can contribute to constipation in palliative care, with the cause usually multifactorial.
Medicines that contribute to constipation include: opioids, anticholinergics, 5HT3-receptor antagonist, some chemotherapy, iron and diuretics.
Non-pharmacologic factors include: reduced patient mobility, reduce fluid and food intake, cognitive impairment, hypercalcaemia, gastrointestinal obstruction.
Prophylaxis is an essential part of managing constipation for a palliative care patient. Consider prescribing a laxative for all patients prescribed drugs that can commonly cause constipation. A patient with minimal oral intake may still require prophylaxis against constipation.
A combination of a stool softener and a stimulant laxative is the best initial choice for the management of constipation for a palliative care patient. Ongoing assessment should continue, and medicines added if necessary, depending on the stool type the patient last produced.
Patients should see their doctors when: Medication/lifestyle measures have been ineffective, the patient experiences abdominal swelling or vomiting or complications are present (faecal impaction, bowel/intestinal obstruction or rectal ulceration).
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.