Treatment Plan

Conservative:

• Increased fluid intake
• Increased fibre intake
• Exercise
• Weight loss
• Healthy eating

Medications (escalating approach):

• Bulking Agents (I.Husk/fybogel – important to drink fluids alongside). If not
effective, then add or switch to Osmotic Laxatives (Lactulose, Macrogol, Phosphate,
& Sodium Citrate Enemas)
• If stool is soft or opioid-induced: Stimulant Laxatives (Senna, Bisacodyl) (if soft stool
with difficulty passing)

• For Faucal Loading:

• 1st try Oral methods:
  • Hard stool (oral macrogols)
  • If still having issues with hard stool/patient has soft stool, try an Oral
    stimulant laxative.
• 2nd try rectal methods:
  • Soft stool (Bisacodyl)
  • Hard stool (Glycerol +/- Bisacodyl)
  • If no response, then consider Docusate/sodium Citrate
  • If the above fails, you can try Arachis Oil

• For Pregnancy & Breastfeeding:

• • Bulking agents are 1st line
  • Osmotic Laxatives are 2nd line
  • If no response, we can consider Glycerol Suppositories
  • If the stool is soft/incomplete, the sensation of emptying: Stimulant Laxatives

For chronic cases:

• A 4-week trial of prucalopride (Prokinetic) if the above unsuccessful
• Manual evacuation (for faecal loading)

Contraindications:

• All laxatives are contraindicated in ileus/intestinal obstruction.
• Avoid bulk-forming laxatives in faecal impaction
• Avoid lactulose in galactosemia/IBD
• Avoid arachis oil in peanut allergy