II. Causes
- Attempt to identify cause
- Do not assume Narcotics are always the cause
III. Differential Diagnosis
IV. Management: Address each of four factors
- See Bowel Regimen in Chronic Narcotic Use
- Low intestinal solids
- Due to decreased Dietary Fiber
- Manage with Psyllium
- Avoid in Dehydration due to stool impaction risk
- Low stool water content
- Causes
- Dehydration
- Slow stool transit time
- Decreased intestinal water secretion
- Management
- Lactulose 30 ml PO every 8 hours until stool
- Sorbitol 30 ml PO q2-4 hours until stool
- Polyethylene Glycol (Miralax) 1 tablespoon (17 g) in 8 oz fluid orally daily
- Magnesium Hydroxide 30 to 60 ml orally at bedtime
- Glycerin suppositories
- Causes
- Low gastrointestinal motility
- Causes
- Non-ambulatory or bed-ridden patient
- Neurodegenerative disease
- Medications
- Management
- See Bowel Regimen in Chronic Narcotic Use
- Senna with Docusate 1 to 2 tabs orally 2 to 4 times daily
- Bisacodyl
- Prune juice
- Casanthranol
- Causes
- Decreased gastrointestinal lubrication
- Due to Dehydration
- Management
- Mineral Oil Enemas
- Glycerin suppositories
- Dioctyl Sodium sulfosuccinate
V. Prevention
- See Bowel Regimen in Chronic Narcotic Use
- Prevention is much easier than treatment
- Administer prophylactic medications with Narcotics
- Gastrointestinal motility Stimulant Laxative and
- Stool Softener
- Example Agent: Pericolace
VI. References
- Albert (2017) Am Fam Physician 95(6): 356-61 [PubMed]
- Hallenbeck (2000) End-of-life Physician Resources #15
- Ross (2001) Am Fam Physician 64(6):1019-26 [PubMed]