Treatment Plan

Treatment Plan

Conservative measures:

• Adequate fluid intake
• Address fibre issues
• Alleviate contributing factors if possible, g., Dehydration & Haemorrhoids

Medications:

• Stimulant laxatives: senna
• Softeners: Docusate
• Combination therapy: stimulant + softener
• Macrogols (osmotic) If the above is not enough: Movicol (also known as Laxido)
• If faecal loading use:
• Suppositories: glycerol (hard stools), bisacodyl (soft stools)
• Enemas: arachis oil (avoid if nut allergy)
• For those taking opioids: Usually start on Senna (Stimulant), if renal issues use stimulant + softener OR Co-danthramer
• Dantron-containing laxatives for terminal/palliative patients if other measures fail

Preventive measures:

• Prophylactic laxatives when starting opiates
• Anti-emetics when starting opiates

Contraindications:

• Avoid phosphate enemas (can cause reduced phosphate & calcium levels in ill patients/renal impaired patients
• Avoid bulk-forming laxatives (ispaghula)
• Avoid PR examination in chemotherapy patients with:

-Neutropenia
-Thrombocytopenia
-Rectal/anal disease