CONSTIPATION & FAECAL INCONTINENCE ALGORITHM

NB: This algorithm summarises the guidelines for management of constipation, especially in the elderly.

FAECAL LOADING?
STOOL CONSISTENCY? with infrequent or unpredictable emptying
(or no motion for 3 days, or “overflow”)
NB This is a short term regime until
regular evacuation is established –
commence oral regime concurrently

Too Hard Too Soft With hard stool With soft/

or “overflow” formed stool

•Increase diet fibre •Loperamide Regular/daily Trial of

(fit/mobile patients only) (titrate dose suppository/enema*: short-term
•Increase fluid intake carefully) •Glycerine suppos oral senna
•Increase mobility if necessary ↓ or
•Osmotic laxative-lactulose add: •Bisacodyl suppos bisacodyl
if necessary add •Codeine (or ‘microlax’)
•Faecal softener –docosate phosphate ↓
•Enema (Fleet oil
NB. Use bulk laxatives (eg &/or phosphate) *
psyllium) only if fluid intake
high – can cause constipation
Commence regular oral regime

Factors associated with Appropriate history REFERRAL if required

constipation/faecal incontinence •Past bowel habit For enema (or suppository
•Sphincter weakness •Awareness of call to not able to be managed by
•Anal sensory loss stool patient):
•Immobility •Stool consistency •Contact GP or a Nurse
•Diet/dehydration •Laxative use/ medication •Prescribe enema or
•Faecal loading •Mobility suppository
(see management above) •Diet •Complete the
•Medication (eg opiate, tricyclic) nursing medication sheet
•Slow colonic transit (eg opiates) Examination to enable follow up.
•Loss of cognitive awareness •Abdominal exam NB. The standard regime &
•Laxative abuse •Anorectal exam protocol may have to be followed
•Bulk laxatives (can constipate if •Digital rectal exam by any attending clinician in the
fluid intake insufficient) •Cognitive assessment times ahead.