Management of Constipation in Adolescents
Assessment and Initial Management
- The National Comprehensive Cancer Network recommends first ruling out impaction, especially if there is any overflow diarrhea accompanying the constipation, and checking for possible obstruction through physical examination in patients with constipation 1, 3
- Evaluation for other potential causes of constipation such as hypercalcemia, hypokalemia, hypothyroidism, diabetes mellitus, or medications is necessary in the assessment of constipation 1, 3
- Discontinuing any non-essential constipating medications if applicable is a recommended initial management step for constipation 4
Treatment Approach for Adolescent Constipation
- Increasing fluid intake and dietary fiber if the patient has adequate fluid intake and physical activity is a first-line intervention for adolescent constipation, as recommended by the National Comprehensive Cancer Network 1, 4
- Encouraging appropriate exercise if the patient's condition allows is also a first-line intervention for adolescent constipation 1, 2
- Ensuring proper toileting habits and privacy is an important aspect of managing constipation in adolescents, as suggested by the Annals of Oncology 5
- Glycerin suppository is an appropriate intervention for constipation that has persisted for several days, and works through local irritation and by drawing water into the rectum, softening stool and facilitating evacuation 1, 2, 5
- Combining glycerin suppository with a mineral oil retention enema may be considered for more complete resolution of constipation 1, 2
Follow-up Management
- If constipation persists after glycerin suppository, reassessing for cause and severity of constipation is necessary, as recommended by the National Comprehensive Cancer Network 1, 3
- Considering adding other laxatives such as bisacodyl suppository, polyethylene glycol, lactulose, or magnesium hydroxide may be necessary for persistent constipation 1, 3, 4
Cautions
- The Annals of Oncology recommends avoiding enemas in patients with neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis 5
- Ensuring the patient is not experiencing symptoms of intestinal obstruction before administering the suppository is crucial, as recommended by the National Comprehensive Cancer Network 1, 2