| [ Summary ] |
Constipation can be defined as infrequent or difficult passage of stool. Constipation is more common in patients with advanced cancer than in elderly people or those with other terminal diseases. Symptoms of constipation are not recognized as important problems. About half of patients who stay in palliative care units complain of symptoms related to constipation. Knowledge of the causes helps with both prevention and treatment. Immobility, poor fluid balance and dietary intake, along with drugs, especially opiates, are major causes of problems in patients receiving palliative care. Assessment of constipation must include establishing in what way the present pattern of bowel movement is different from the normal pattern and a physical examination, including general observation, abdominal palpation, and rectal examination is necessary. Occasionally, despite examinations, diagnosis of constipation is not clear. A plain X ray of the abdomen can be helpful. We also give advice on diet and mobility, the most important management tool for constipation is use of laxatives. We should use prophylactic laxatives when we begin use of morphine for pain relief. When choosing laxatives, we must consider the mechanisms of action with laxatives. However, the aim of laxative therapy is to achieve comfortable defecation rather than frequency of evacuation. We must give attention to other symptoms because almost all of these patients have pain. Although assessment of constipation is very complex in the end stage, we must try to care considerately for patients to relieve one source of their pain and support their QOL. |