There remains a lack of clear evidence to guide the management of constipation in clinical practice, especially at the end of life. Often, clinical approaches to tackle this common and distressing problem are based only on experience and anecdotal evidence. This situation is less than ideal. Constipation at the end of life may present additional problems, as conventional therapies may be unsuitable or inappropriate. This can create a considerable challenge to those caring for individuals with life-limiting illnesses. As in other situations, an understanding of the pathophysiology, causes and assessment of constipation is useful and will be discussed in this article. Approaches to the management of this common problem are presented, with particular reference to end-of-life care. Palliative care, in this context, is taken to include patients with cancer and those with non-malignant end-stage illness. Conflicts of interest: Dr Lawrie is a member of the Faculty of Specialists, a group of pain management specialists which received start-up funding for its activities from Napp Pharmaceuticals
- End-of-life care
- Evidence-based management
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