Management of Constipation

For Impacted Stool:

1. Priority: Phosphate enema, especially critical in severe cases.

2. Alternative: For young and healthy individuals with no co-morbidities, starting with glycerol suppositories is advisable.

For Hard Stool:

i. Recommendation: Utilizing stool softeners can be beneficial.

General Interventions for Constipation:

Conservative measures:

. High-fibre diet

. Increased fluid intake

. Regular exercise

Medications:

First line: Senna (Stimulant laxatives)

Second line: Lactulose or Macrogol (Osmotic “Bulk-forming” Laxatives)

Additional support:

Prokinetic agents such as domperidone, metoclopramide, erythromycin

Consultation:

Seeking specialist advice if the above strategies fail.

Note:

• Senna is generally preferred before lactulose.

During pregnancy, the approach changes slightly:

i. First line: Ispaghula (Bulk-forming laxative)

ii. Second line: Lactulose (Osmotic laxative)

iii. Third line: Senna (Stimulant laxative), though it might cause abdominal discomfort.