SHM's Clinical Quick Talks-Approach to Inpatient Bowel Regimen in Adults

Pdf Summary

Constipation is common in hospitalized adults and may cause substantial discomfort or complications, including fecal impaction, stercoral colitis, and bowel obstruction. It may present with infrequent or difficult bowel movements, abdominal pain or distension, nausea, reduced appetite, or—in older adults—delirium or agitation. Risk factors include older age, low fiber or fluid intake, reduced mobility, neurologic or endocrine conditions, recent surgery, and medications such as opioids and anticholinergics.<br /><br />Assessment is primarily clinical. Review medications, encourage ambulation and hydration, and consider examination or testing based on the presentation. Perform a rectal examination when impaction is suspected. Blood in the stool, unexplained weight loss, inability to pass gas, an abdominal mass, iron-deficiency anemia, or peritoneal signs warrant particular concern. Nausea, vomiting, and distension may indicate obstruction; exclude obstruction before giving laxatives. Imaging and specialist consultation may be appropriate when obstruction, perforation, volvulus, refractory constipation, or a motility disorder is suspected.<br /><br />For initial treatment, use low-volume polyethylene glycol (PEG) and/or senna. If constipation persists for 48 hours, consider a magnesium-based agent after checking renal function; avoid these agents in end-stage renal disease. At 72 hours, escalate by adding bisacodyl and/or lactulose. At 96 hours, reassess for obstruction or impaction and consider imaging or an appropriate enema. Manual disimpaction may be needed for fecal impaction, and peripherally acting μ-opioid receptor antagonists may be used for opioid-induced constipation.<br /><br />Docusate should not be used alone because evidence for its effectiveness is limited. Sodium polystyrene sulfonate is not a constipation treatment. High-volume PEG is generally reserved for bowel preparation or selected severe or refractory cases, typically under medical supervision.

Asset Subtitle

Rahul Ramakrishnan, Kevin Kuang, Tyler McMillan

Meta Tag

Concept Constipation

Concept Fecal Impaction

Concept Bowel Obstruction

Concept Clinical Evaluation

Concept Stepwise bowel regimen

Keywords

constipation

hospitalized adults

fecal impaction

stercoral colitis

bowel obstruction

opioid-induced constipation

polyethylene glycol

senna

laxatives

manual disimpaction

Constipation

Fecal Impaction

Bowel Obstruction

Clinical Evaluation

Stepwise bowel regimen