Management

Increasing fibre intake and exercise may improve the symptoms and prevalence of constipation (1).

• drugs - laxatives - should not be used as the usual first line treatment in constipation. Any underlying cause of should be treated. Mobilize the patient and provide a diet rich in fibre and ensure adequate fluid intake. Only consider the use of drugs if above measures fail - short course of laxatives may relieve symptoms and restore normal bowel function
• prolonged treatment with laxatives is not generally necessary. However, this may be required in situations where constipation or faecal impaction may re-occur if treatment is stopped (e.g. those who are immobile through age or illness, or receiving opioids in palliative care, and for some children to prevent relapse)
• there is little clinical evidence on which to judge the relative effectiveness and tolerability of individual laxatives. Therefore, choice should be based on symptoms, patient preferences, side effects and cost of medicines

If faecal impaction

• then treatment with an enema (e.g. phosphate enema) generally leads to resolution. Enemas may need to repeated several times in order to clear impacted faeces
• Movicol (R) is licensed for the treatment of faecal impaction in adults

Manual evacuation of faeces is almost never needed.

Reference:

1. Mueller-Lissner SA, Wald A. Constipation in adults. BMJ Clin Evid. 2010 Jul 5;2010:0413. PMID: 21418672; PMCID: PMC3217654.