What this protocol covers
The constipation query at the counter: what is changed first, which laxative fits each case, and which changes in bowel habit are not treated without a doctor.
1. What to ask
- Is it a change from what is usual for them? Since when?
- Have they seen blood or black stools? Have they lost weight?
- Do they have severe pain, a swollen tummy, vomiting, or are they not passing wind?
- Do they take opioids, iron, calcium, antidepressants or bladder medicines?
- What is their diet like, how much water do they drink and how active are they?
2. Refer if any of these appear
- A recent change in bowel habit from the age of 50.
- Blood in the stools, black stools, weight loss or tiredness from anaemia.
- Severe pain, a swollen abdomen, vomiting or not passing wind: it could be an obstruction.
- More than 2 weeks without response to measures and a laxative.
- A young child with pain when opening their bowels or with blood.
3. If there are no red flags
First
- More fibre (fruit, vegetables, pulses, wholegrain cereals), more water and more movement.
- A routine: after breakfast is when the bowel helps most.
If that is not enough
- A bulk-forming laxative (ispaghula) always with a good glass of water; it takes 2-3 days.
- Or an osmotic one (macrogol, lactulose), which can be used for longer; lactulose causes wind.
For an occasional need
- A stimulant (bisacodyl, senna) at night, only occasionally.
- A glycerol suppository, which works within minutes.
4. Adjust to who will take it
- Pregnancy
- Fibre, water and, if needed, macrogol or lactulose. Stimulants only on medical advice.
- Children
- Fibre and water; if that is not enough, the doctor may advise macrogol. Glycerol for an occasional need.
- Older people
- With opioids, an osmotic laxative from the start. Ispaghula only if they drink enough: without water it can form a blockage.
- Long-term conditions
- Someone on regular opioids usually needs a laxative on a schedule: their doctor should review it.
What not to recommend
- Stimulant laxatives every day.
- Liquid paraffin in older or bedbound people: if inhaled, it damages the lungs.
- Ispaghula without enough water or in bedbound people.
- Repeated enemas.
What to say at the counter. First fibre, water and moving; if that is not enough, this with a good glass of water and give it two or three days. If you see blood, lose weight or it is a new change, see the doctor.
Pharmacy Pills · conveniodefarmacia.com
Patient sheet: constipation
To print and hand over. It carries only what the patient needs at home.
- Eat more fruit, vegetables, pulses and wholegrain cereals, and drink water through the day.
- Walk or do some exercise every day.
- If you take ispaghula, always with a large glass of water.
- Do not use stimulant laxatives every day.
- See your doctor if you see blood, lose weight, have severe pain or it is a recent change in your bowel habit.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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A recent change in bowel habit after 50 with weight loss is a red flag.
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A bulk-forming laxative without enough water can make constipation worse and even cause an obstruction.
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Opioids slow the bowel; an osmotic laxative from the start is the usual option.
Training content. It does not replace the summary of product characteristics or clinical judgement.