July 2020 – Deliver a one-two punch: increase gut motility and stool moisture with scheduled meds.
Constipation is predictable. Think hospitalization, immobility, newly prescribed opioids, traveling, hot weather.
Constipation is miserable. Be a hero. Prevent it.
Simple advice may be all that’s needed: “Take 1-2 prunes and an extra glass of water with every dose of pain meds.”
For higher-risk patients (prior constipation or hospitalized), we use twice daily senna (up to 8 tabs per day) AND daily Miralax or lactulose. In the hospital, PRN is not good enough.
For already constipated patients, consider how quickly you need to get results and whether there is a need for rectal disimpaction. Fast-acting meds include methylnaltrexone (for opioid-induced constipation), bisacodyl suppositories, enemas, and oral magnesium citrate.