Common Causes of Constipation in Patients with Advanced Illness cont’d

Mechanical

  • Obstruction or pseudo-obstruction (Ogilvie’s)
  • Ascites
  • Caricinomatosis

Miscellaneous

  • Pain: generalized or rectal
  • Lack of privacy, awkward positioning (bedpan)
  • Loss of normal bowel routine
  • Lack of fluid intake
  • Delirium

Opioid Induced Constipation

Multifactorial causality

  • Opioid binds to gut and central nervous system receptors
  • Decreased bowel fluid secretion and/or increased absorption
  • Increased tone and non-propulsive activity - the gut is moving, just not in the normal coordinated manner