Constipation – in Palliative care

Constipation in palliative care -One of the most frequently encountered symptoms in palliative care ( particularly those with advanced cancer ) Potential to significantly impair quality of life ( unpleasant physical symptoms and psychological preoccupation ) About 80 % of people with cancer will require treatment at some time Poorly recognized under-treated and there is uncertainty about the best management of constipation and variation in practice between palliative care settings

definition- Definition is highly subject Infrequent ( relative to patients normal bowel habit ) difficult passage of small hard faeces It is possible to be constipated and have normal or even soft stools --> eg failure if propulsion by the bowel (opioid induced or neuropathic constipation ) Constipation can lead to○ nausea○ vomiting○ anorexia○ overflow diarrhoea

Causes - cancer related -Bowel obstruction Compression or infiltration of lumbosacral spinal cord , cauda equina or pelvic plexus Hypercalcemia caused by cancer Painful defecation Autonomic neuropathy Drugs -Opioids 90 % will need laxatives Drugs with antimuscarinic effects○ cyclizine○ hyoscine○ phenothiazines○ tricyclics Ondansetron / granisetrontropisetron Diuretics Iron Anti-parkinsons , antacids , anti-convulsants , anati-diarrhoeals , neuroleptics , antidepressants functional factors -Inadequate fluid intake Dehydration Weakness or dyspnoea Confusion Immobility Anorexia Low fibre diet Lack...