Adult Constipation and Faecal Impaction Including Laxative Sachet Disimpaction Plan

                                                                                                     

 

Introduction

Constipation means opening bowels less than 3 times a week, or having hard, dry poo (stools) which may be large or come out as tiny pellets. It may be that you often need to strain to pass stool.

What Causes Constipation?

Constipation in adults has many possible causes. Sometimes there’s no obvious reason.

The most common causes include:                                     

• Not eating enough fibre, which is found in fruits, vegetables and cereals
• Not drinking enough fluid
• Not moving enough and spending long periods sitting or lying down
• Being less active and not exercising
• Often ignoring the urge to go to the toilet
• Changing your diet or daily routine
• Stress, anxiety or depression
• During pregnancy and 6 weeks after giving birth
• Some medicines, including certain painkillers, antidepressants, medicines for indigestion called antacids, and iron tablets.

As well as causing a change in your bowel habits it may also cause the following symptoms:

• Stomach aches and pain
• Feeling bloated
• Feeling nauseous
• Loss of appetite

Treatment and prevention:

Making changes to your diet and lifestyle can help to make your stool softer and easier to pass. Try to:

• eat regular meals
• make sure that your diet is healthy and balanced, with whole grains, vegetables, and fruits or fruit juice such as apples, apricots, grapes, raisins, peaches, pears, plums, prunes, raspberries, or strawberries
• gradually increase your fibre intake by eating more bread made with wholemeal (wholewheat or wholegrain) flour, wholegrain breakfast cereals, brown rice, wholemeal pasta, and fruit and vegetables
• eat at least 5 different types of fruit and vegetables each day
• drink at least 2 litres of fluid each day (about 8 to 10 cups)
• go for a daily walk or run - this can help you pass stool regularly
• avoid alcohol because it dehydrates you, even though it is a fluid
• find a place and a time of day when you can spend time on the toilet
• respond to your body - when you feel the urge to go to the toilet, do not delay
• rest your feet on a low stool while you are using the toilet if it is comfortable - having your knees above the level of your hips can make it easier to pass stool

Medicines that can help

• Ispaghula husk, macrogol and lactulose work by softening your stool to make it easier to pass. If you do not pass normal stool within 3 days, go back to the pharmacy for further advice.
• Senna and docusate are stimulant laxatives that work by stimulating your gut muscles to help move stool along your bowel. Docusate also softens stool.

Most laxatives can cause side effects such as bloating, flatulence (farting or wind), feeling sick, and some tummy pain, but these are usually mild and get better over time. Keep drinking plenty of water while you’re taking the laxative. Stop taking the laxative when your stool becomes easier to pass again.

If you do not pass normal stool within 3 days contact your GP or NHS 111

Always read the patient information leaflet that comes with your medicine. If you are concerned about any side effects from a treatment, report it to a doctor, nurse or pharmacist.

 

Faecal Impaction Including Laxative Sachet Disimpaction Plan

You may have been advised that you have Faecal Impaction. This is very bad constipation where stool can build up in the abdomen and become immobile in the intestines. You may pass very small stools every few days or have very infrequent bowel movements. You may have ‘leaks’ of stools causing soiling, where soft stool has bypassed other hard stool, out of your control (overflow).

Disimpaction is the treatment to give relief from Faecal Impaction. This involves giving gradually increasing doses until the stool in the intestines has become liquid and comes out as diarrhoea and then switching to a maintenance dose.

• Dissolve each sachet in 125ml (one quarter of a pint) of water. Total dose must be drunk within a 6-hour period.
• If you have a heart condition do not take more than 2 sachets in any one-hour period
• An additional 1 litre of fluid should be drunk daily whilst taking Movicol or Laxido.

DAY 1 – 4 sachets Movicol or Laxido. If bowel motion type 7 (SEE CHART BELOW) for 24 hours switch to 1 to 2 satchets daily for two weeks. 

DAY 2 – if no bowel motion or not Type 7 take 6 Movicol or Laxido sachets. If bowel motion type 7 for 24 hours switch to 1 to 2 satchets daily for two weeks.

DAY 3-7 – if no bowel motion or not Type 7 stool take 8 Movicol or Laxido sachets.  If bowel motion type 7 for 24 hours switch to 1 to 2 satchets daily for two weeks.

DAY 7 - If still no bowel motion see GP ASAP. Continue at 8 sachets a day if bowel motion not at Type 7.

Day 10 – if bowel motion not at Type 7 – contact GP