Constipation


Background

Pathophysiology

Diagnostics

Treatment

  1. Initial/Prep/Goals
  2. Medical/Pharmaceutical
  3. Surgical/Procedural
  4. Prevention
Medications for treatment of constipation
Medication Usual adult dose Onset of action Side effects
Bulk-forming laxatives*
Psyllium Up to 1 tablespoon (≅3.5 grams fiber) 3 times per day 12 to 72 h Impaction above strictures, fluid overload, gas and bloating
Methylcellulose Up to 1 tablespoon (≅2 grams fiber) or 4 caplets (500 mg fiber per caplet) 3 times per day 12 to 72 h
Polycarbophil 2 to 4 tabs (500 mg fiber per tab) per day 24 to 48 h
Wheat dextrin 1 to 3 caplets (1 gram fiber per caplet) or 2 teaspoonsful (1.5 gram fiber per teaspoon) up to 3 times per daily 24 to 48 h
Surfactants (softeners)
Docusate sodium 100 mg 2 times per day 24 to 72 hours Well tolerated. Use lower dose if administered with another laxative. Contact dermatitis reported.
Docusate calcium 240 mg 1 time per day 24 to 72 hours
Osmotic agents
Polyethylene glycol (macrogol) 8.5 to 34 grams in 240 mL (8 ounces) liquids 1 to 4 days Nausea, bloating, cramping
Lactulose 10 to 20 grams (15 to 30 mL) every other day. May increase up to 2 times per day. 24 to 48 hours Abdominal bloating, flatulence
Sorbitol 30 grams (120 mL of 25 percent solution) 1 time per day 24 to 48 hours Abdominal bloating, flatulence
Glycerin (glycerol) One suppository (2 or 3 grams) per rectum for 15 minutes 1 time per day 15 to 60 minutes Rectal irritation
Magnesium sulfate One to two teaspoonsful (5 to 10 grams) dissolved in 240 mL (8 ounces) water 1 time per day 0.5 to 3 hours Watery stools and urgency. Caution in renal insufficiency (magnesium toxicity).
Magnesium citrate 200 mL (11.6 grams) 1 time per day 0.5 to 3 hours
Stimulant laxatives
Bisacodyl 10 to 30 mg as enteric coated tabs 1 time per day 6 to 10 hours Gastric irritation
10 mg suppository per rectum 1 time per day 15 to 60 minutes Rectal irritation
Senna 2 to 4 tabs (8.6 mg sennosides per tab) or 1 to 2 tabs (15 mg sennosides per tab) as a single daily dose or divided twice daily 6 to 12 hours Melanosis coli
Other
Lubiprostone 24 micrograms 2 times per day 24 to 48 hours Nausea, diarrhea
Linaclotide 145 micrograms 1 time per day 12 to 24 hours Diarrhea, bloating

Disposition

  1. Admit Indications/orders
  2. Consultations
  3. Check-ups/Follow-up