Constipation in palliative care

Possible causes of constipation include illness, nutrition, medication, reduced bowel motility, or faecal matter becoming too dry.

Constipation may occur even if the patient isn’t eating much, because stool is produced by the digestive system itself as well. In addition, if the patient’s general condition is poor, constipation may become worse due to reduced physical activity as well as need for assistance when it comes to passing stools.

It’s important to have regular bowel movements. When preventing and treating constipation, the patient should be given enough time and privacy. The patient’s diet should contain enough fibre and fluids; however, if the patient is in poor condition, it’s often both impossible and unnecessary to achieve this. The patient should remain physically active according to their capacity. If the patient is taking strong pain medicines, they should be taking a regular laxative as well.

Treatment with medication

In palliative care, treatment of constipation is founded on medication, most commonly in the form of stool softeners or laxatives that stimulate the muscles in the bowel. In the case of severe constipation, both types of medications are used at the same time. Fibre products that work by increasing the bulk of stool are not recommended, since they should be taken with plenty of fluids, which is rarely possible in palliative care.

The dosage of constipation medication varies based on individual needs, and doses are increased one step at a time until stools are soft and the patient has bowel movements at least every 3 days. Suppositories and enemas are generally avoided, but may sometimes be used as immediate relief for severe constipation. Plans for how to prevent and treat constipation should be made in collaboration with the care team. In other words, it’s important to talk about bowel movements.

• Constipation medication is more effective if taken with enough fluids. Drink according to what you feel capable of.

• Having enough fibre in the diet relieves constipation. When eating foods high in fibre, you should also make sure you’re getting enough fluids. All plant-based foods, such as grains, fruits, vegetables, and berries, contain fibre. Adjust your diet to your overall situation.

• Be physically active, according to your capacity.

• When going to the toilet, give yourself enough time.

• Having a good position helps empty the rectum. To relax the pelvic floor muscles, keep your knees higher than your hips. A footstool beneath your feet may help you achieve a better position for pushing, especially if you’re using a toilet seat raiser.

• Rinsing with warm water relaxes the anal sphincter and may make it easier to pass stools.