Adequate fluid (1.5L per day)
Fiber (10gm per day)
Bran: 1 cup daily
Psyllium (Metamucil): 1-2 teaspoon TID
Exercise
Bran: 1 cup daily
Psyllium (Metamucil): 1-2 teaspoon TID
Emollient
Docusate (Colace): 100mg QD-BID (facilitates mixture of stool fat and water)
Mineral oil (long term use causes malabsorption)
Stimulants
Bisacodyl (Dulcolax): 10mg PR TID
Senna: Two tab PO QD-BID
Saline laxative
Milk of mangesia: 15-30 mL QD-BID
Magnesium citrate: 100-240 mL QD-BID
Hyperosmolar agents
Lactulose 15-30 mL QD-BID
PEG: 1 gallon/4h
PEG(Miralax): 17gm
Glycerin: 1 adult suppository PR, onset of action 15-30 min, then 1-2 doses per day
Enemas
Soap suds, saline, tap water enema (rectal distention, causing evacuation)
May add 50-100 mg of docusate liquid to saline or water enema
Fleet Phospho-soda: 118 ml single enema dose, with maximum of x2 doses at least 1 hr apart
No more than 2 doses in a 24 hr period may be administered without serum phos, mag, calcium levels
May observe hyperphosphatemia, hypocalcemia, hypomagnesemia
High risk patients: renal impairement, abnormal gut motility, IBD, elderly, cardiac co-morbidities
Docusate (Colace): 100mg QD-BID (facilitates mixture of stool fat and water)
Mineral oil (long term use causes malabsorption)
Bisacodyl (Dulcolax): 10mg PR TID
Senna: Two tab PO QD-BID
Milk of mangesia: 15-30 mL QD-BID
Magnesium citrate: 100-240 mL QD-BID
Lactulose 15-30 mL QD-BID
PEG: 1 gallon/4h
PEG(Miralax): 17gm
Glycerin: 1 adult suppository PR, onset of action 15-30 min, then 1-2 doses per day
Soap suds, saline, tap water enema (rectal distention, causing evacuation)
May add 50-100 mg of docusate liquid to saline or water enema
Fleet Phospho-soda: 118 ml single enema dose, with maximum of x2 doses at least 1 hr apart
No more than 2 doses in a 24 hr period may be administered without serum phos, mag, calcium levels
May observe hyperphosphatemia, hypocalcemia, hypomagnesemia
High risk patients: renal impairement, abnormal gut motility, IBD, elderly, cardiac co-morbidities
No more than 2 doses in a 24 hr period may be administered without serum phos, mag, calcium levels
May observe hyperphosphatemia, hypocalcemia, hypomagnesemia
High risk patients: renal impairement, abnormal gut motility, IBD, elderly, cardiac co-morbidities
Gastrografin through NG or OG decreases bowel wall edema and increases bowel motility
Diagnostic and therapeutic
100 cc of gastrografin through NG tube
Transit may be observed through serial radiographs
Contrast within the large bowel within 24 hrs suggest partial small bowel obstruction
Contrast failing to reach large bowel within 24-48 hrs suggests complete obstruction, requiring laparotomy
Therapeutic, may reduce necessary operative rate by ~75%
Avoid barium as it becomes inspissated in bowel, causing complete obstruction
If perforation occurs with barium, leakage can be lethal
Gastrografin is water-soluble and relatively safer if perforation occurs
Be aware that anaphylactoid reactions and serious aspirations have occurred rarely with Gastrografin, however
Diagnostic and therapeutic
100 cc of gastrografin through NG tube
Transit may be observed through serial radiographs
Contrast within the large bowel within 24 hrs suggest partial small bowel obstruction
Contrast failing to reach large bowel within 24-48 hrs suggests complete obstruction, requiring laparotomy
Therapeutic, may reduce necessary operative rate by ~75%
Contrast within the large bowel within 24 hrs suggest partial small bowel obstruction
Contrast failing to reach large bowel within 24-48 hrs suggests complete obstruction, requiring laparotomy
If perforation occurs with barium, leakage can be lethal
Gastrografin is water-soluble and relatively safer if perforation occurs
Be aware that anaphylactoid reactions and serious aspirations have occurred rarely with Gastrografin, however
Constipation
Behavioral-related
Dysuria
Lack of exercise
Dysphagia
Diet-related
Hiccups
Fecal impaction