Management of Constipation in Palliative Care

Assessment and Causes

The National Comprehensive Cancer Network recommends ruling out impaction and obstruction through physical exam and abdominal x-ray 1
The National Comprehensive Cancer Network suggests identifying and treating reversible causes including hypercalcemia, hypokalemia, hypothyroidism, diabetes mellitus, and medication effects 1, 2
Consider plain abdominal X-ray to assess extent of fecal loading and exclude bowel obstruction in severe cases 3

For patients with years of life expectancy, the National Comprehensive Cancer Network recommends increasing fluid intake and encouraging physical activity 1, 3
For patients with years of life expectancy, the National Comprehensive Cancer Network suggests increasing dietary fiber only if patient has adequate fluid intake and physical activity 1, 2
Administer prophylactic laxatives, especially when starting opioids, as recommended by the National Comprehensive Cancer Network 1, 4

The National Comprehensive Cancer Network recommends a first-line approach of combination of a stimulant laxative with or without a stool softener 2
The National Comprehensive Cancer Network suggests adding osmotic laxatives as a second-line approach 1
For opioid-induced constipation, consider peripherally acting μ-opioid receptor antagonists like methylnaltrexone, as recommended by the National Comprehensive Cancer Network 2

Failing to provide prophylactic laxatives when starting opioid therapy, as cautioned by Praxis Medical Insights 4
Relying solely on stool softeners without stimulant laxatives, as warned by the National Comprehensive Cancer Network 2, 4
Depending exclusively on lifestyle modifications without pharmacological intervention in advanced disease, as noted by Annals of Oncology 3

Annals of Oncology recommends ensuring privacy and comfort for normal defecation 3
Annals of Oncology suggests proper positioning and considering abdominal massage 3