Caring for Palliative Patients With Chronic Constipation

Constipation The Management of Constipation in Palliative Patients Which strategy is considered the best when nurses must intervene with a patient suffering from constipation? The PubMed publication put out by the National Institutes of Health and the U.S. National Library of Medicine explains that there is some uncertainty within the healthcare field about the choice between managing constipation with drugs (pharmacologically) or with other various clinical programs in palliative care settings (Clemens, et al., 2013).

A section in the Oxford Textbook of Palliative Nursing dedicated to bowel management -- written by researcher Denice Caraccia Economou -- explains that there is no absolute rule as to what intervention is best (220). Pharmacological Management: The use of opioids is not always recommended for constipated patients, because they increase electrolyte and water absorption in both intestines which can lead to dehydration and dry, hard stools, according to Economou (221).

Also morphine is not a recommended intervention because of the insensitivity it creates which prevents the patient from sensing that he needs to have a bowel movement. In terms of pharmacological management, lubricant laxatives (mineral oil laxatives) can cause some leaking from the rectum hence they are not recommended.

When patients use bulk laxatives (without additional fluids) they risk bowel obstruction and hyperglycemia, and the use of surface or detergent laxatives can help by increasing absorption of water and fats, and can lead to a reduction of electrolytes in the small and large intestines (Economou, 221). Osmotic laxatives (Milk of Magnesia; Miralax; etc.) tend to increase fluid secretions in the small intestines and to some degree in the large intestines -- and they lower ammonia levels -- which is helpful.

Suppositories are often rejected by some patients because they bring to mind an unpleasant concept, but they produce bowl movements quickly and hence, they are a recommended source of pharmacological management (Economou, 222). When palliative patients do not respond to standard laxatives, Economou reports that Relister has shown good success toward dealing with constipation. Non- Pharmacological interventions: Nurses should encourage the use of fluids as a priority, especially for diabetic patients, who may be taking opioids (which increases the risk of constipation).

Economou stresses the need for nurses to determine if the constipation has become an obstruction, and X-ray interventions can help determine the extent to which the constipation is blocking normal bowel functions, but in palliative care the use of X-ray technology is not recommended. But fluids should be an important part of non-pharmacological interventions because even an increase of 100 ml. of water can help a patient's bowels to function better. Among the strategies Dr. John F.

Johanson recommends for palliative patients with no known secondary reasons for constipation are: regular exercise (where appropriate), increased fluid intake; bowel habit training (where appropriate), use of high fiber foods, biofeedback, and even electric stimulation (where appropriate) (Johanson, 2011). Johanson explains that biofeedback strategies involve the actual retaining the pelvic and sphincter muscles through the use of a small electronic probe or a small balloon. Studies (among 36 older patients) show that patients were able to greatly increase the number of bowl movements they had (Johanson, p. 8).

Other non-pharmacological remedies include: a) a solution of water mixed with sugars, salt and electrolytes; b) a mixture of rice, applesauce, toast and bananas; c) smaller bland meals; d) staying away from alcohol, bran, hot spices and other.