Palliative Care
Management of constipation
Combined softener and stimulant
This combination is commonly prescribed for treatment of constipation in the terminally ill. Co-danthramer contains 2 active ingredients; dantron (stimlulant laxative) and poloxamer 188 (faecal softener). The latter attracts water into the stools so the moisture content and volume is increased which therefore softens it. This makes the process less uncomfortable because the stools can pass through easily.
-
It takes 6-12 hours to exert effect and can be given at night so that effect is in place the following morning. Available as capsules or suspension in regular or strong versions.
-
Dose: Regular co-danthramer orally (1-2 capsules) or available as suspension (5-10ml) taken at bedtime.
Strong co-danthramer orally (1-2 capsules) or a preparation of suspension is available ( 5ml daily) at night.
Side effects are colouration of urine to red, irriation so
prolonged contact with the skin should be avoided especially in incontinent patients
or infants in diapers.
Rectal treatments
This type of treatment should not be initiated in patients who are on chemotherapy with
neutropenia because of risk of infection.
-
Bisacodyl suppository (10mg) is inserted in the morning with a latency period of
15 to 60 minutes (compared to oral 6-12 hours) because there is rapid conversion of bisacodyl into the active form (desaacetyl form) by the colonic flora. It is important that the suppository is in contact with the mucosa of the rectum because this is the site where the flora activity occurs.
-
Glycerol suppository (1 inserted each time) takes 15-30 minutes to have an effect. It is an osmotic agent which absorbs water into the stool to increase
the water content and hence soften faeces.
-
Phosphate enema takes 15-30 minutes for effect and is useful in faecal impaction. However, it may cause local irritation and is not recommended in patients aged over 65 years old because of the potential disturbances in electrolyte and water levels.