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St Christopher’s Hospice clinical guidelines: Managing constipation with laxatives

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Introduction

Constipation tends to be characterised by infrequent bowel evacuations, hard, small faeces or difficult or painful defecation (Maestri-Banks and Burns, 1996; Thompson et al, 1999; Brown et al, 2006; Longstreth et al, 2006). Patients with an ECOG (Eastern Cooperative Oncology Group; Oken et al, 1982) performance status 3 or 4 are at high risk of developing constipation (Figure 1). Approximately 45% of hospice patients are constipated on admission (Goodman et al, 2005). Patients on, or commencing, opioid therapy are at high/inevitable risk of constipation (Sykes, 1998). Assessment is essential to effective bowel management and an accurate history is necessary to understand the patient’s normal and acceptable bowel pattern. A normal bowel pattern ranges from three bowel actions a day to …

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