According to the multidisciplinary working group, which formulated the new recommendations, early detection of constipation is one of the biggest bottlenecks, especially in the case of reduced mobility. Prevention also often proves problematic because patients have difficulty taking medication and taking sufficient fluids. Moreover, in the (pre) terminal phase there is often a need to give opioids, but the oral intake and ingestion of laxatives then cause problems.
Up to 71% of patients in the palliative phase have constipation. Patients with cancer are particularly constipated in the months before death.
An important recommendation in the guideline is to regularly ask about constipation, to monitor it systematically and to be alert to signs, for example using a measuring instrument such as the Bristol Stool Scale (BSS). Or the less well-known Bowel Function Index (BFI) when using opioids.
The working group also advises patients to have sufficient fiber and fluid intake per day, to encourage physical activity and to discontinue medication with constipation as a side effect.
Laxantia
If the precautionary measures are insufficient, the guideline states to start with laxatives (osmotic laxatives; macrogol MgOH or lactulose), to increase them or to add another laxative (contact laxatives; bisacodyl).
When starting morphine mimetics: start immediately with an osmotic laxative. If the effect is insufficient after increasing osmotic laxatives, possibly combined with contact laxatives, it is recommended to discontinue the laxatives and start with pamoras (oral naloxegol or methylnaltrexone sc).
The new guideline Constipation in the palliative phase is on the website Pallialineand a summary of the guideline can be found in the PalliArts app.