Constipation is CKD is multifactorial, and associated with:
- Poor dietary fibre intake
- Fluid restriction
- Medications (phosphate binders, opioids, amitriptyline, ondansetron, oral iron supplements)
- Co-morbid gastrointestinal disorders
- Lack of physical activity
- Increase dietary fibre intake (e.g. fruits, vegetables, grains and cereals).
For people with ESKD (eGFR <20ml/min) or hyperkalemia we recommend low potassium dietary choices.
- Fibre supplements
- OTC fibre supplements are available. Some may contain high levels of potassium (e.g. prunelax) or are not suitable for people on fluid restrictions (e.g. psyllium husk, Metamucil).
- Benefibre is the most suitable option for people with ESKD.
- Dosing should start at 1 tsp per day, increase dosing until constipation is resolved (up to a maximum of 6 tsps. /day).
- Titrate slowly as there may be s/e of bloating.
- Benefibre has no flavour and can be mixed with any fluids or foods containing moisture (e.g. yoghurt, soups, stews).
- Reach fluid targets, but not over fluid restriction.
- Increase physical activity, aiming for 30mins each day.
- Coloxyl + senna. Start with 2 tablets at night, and up-titrate as required to maximum 2 tds (long term senna use not recommended due to risk of dismotility).
- Movicol. Start with 1 sachet daily. Up-titrate up as required.
Low in potassium.
Must be mixed with water as per packet instruction. Water is not absorbed and therefore does not contribute to fluid restriction.
- Lactulose. Start at 15ml daily. Can cause faecal urgency.
- Glycerine and Bisocodyl suppositories (available over-the-counter)
- High olive oil enema
- For faecal impaction, use bowel prep such as Glycoprep
- Fleet drops and fleet enemas are high in phosphate, so are only suitable for patients with low phosphate