New information pack guides GPs on best practice management of constipation

Published by the Bowel Interest Group (BIG), the pack summarises key research on constipation and treatment options to provide a best practice pathway for general practice in simple diagrammatic form.

Stimulant laxatives such as senna are recommended second-line if bulk-forming laxatives are ineffective. | DR JOHN BRACKENBURY /SCIENCE PHOTO LIBRARY
Stimulant laxatives such as senna are recommended second-line if bulk-forming laxatives are ineffective. | DR JOHN BRACKENBURY /SCIENCE PHOTO LIBRARY

BIG is an independent multidisciplinary organisation dedicated to improving bowel health. In its 2019 'Cost of Constipation Report' BIG states that up to one in seven adults and one in three children are affected by constipation and that in 2017/18 over 71,000 people in England were admitted to hospital with constipation, costing NHS England an estimated £162m. BIG proposes that many such admissions could be avoided if identified and managed at the primary care stage.

Lack of guidelines

In a survey of 147 GPs, nurses and other healthcare professionals conducted by BIG in July 2019 a fifth of respondents said the biggest challenge they faced when managing patients with constipation was a lack of guidelines, while knowledge of appropriate treatments and knowing when to refer were cited as the biggest challenges by 10.9% and 3.4% of respondents, respectively. 

The new information pack, 'Dealing with Chronic Constipation, Information for General Practitioners' outlines the management of chronic constipation through key therapeutic stages, ensuring that patients are not left for long periods with treatments that aren't working.

Bowel Dysfunction Treatment Pyramid

The information, based on the NICE Clinical Knowledge Summary on constipation, is presented as a simple pyramid diagram to provide a best practice pathway for the recognition, treatment and point of escalation of the available therapies for chronic constipation.

Treatment should begin at the base of the pyramid with standard interventions, such as laxatives and dietary changes, moving up if needed through various other interventions such as digital stimulation and transanal irrigation to stoma at the pyramid's tip. The diagram summarises research on the period for each therapy to be tested before moving up to the next alternative.

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