Using NICE Clinical Knowledge Summaries to support recommendations
Using NICE Clinical Knowledge Summaries to support recommendations
Customers can manage their short-term constipation with lifestyle changes and pharmacy products (where necessary).
The NICE Clinical Knowledge Summary (CKS) for short-term constipation is a useful framework to follow when making recommendations.4 The CKS is for prescribers, but can be used as a basis for OTC recommendations.
Note: When using the NICE CKS to inform your OTC recommendations, check packaging carefully to see if products can be recommended with other laxatives, to confirm directions for use, and to check appropriate length of treatment.
Step 1Lifestyle assessment
Discuss with the customer any recent changes in lifestyle/diet that may have contributed to the symptoms and, where appropriate, manage any underlying secondary cause (e.g. consider reducing dose or stopping medication that is causing the symptoms).
Step 2Lifestyle changes
a. Increase fibre intake
Particularly wholegrains, fruits high in sorbitol (e.g. raisins, apples, plums, prunes). Adults should aim to eat 30g per day. Increasing intake should be done gradually to reduce bloating/excess wind. Remind customers that it can take several weeks to see the benefits of increasing fibre in the diet.
b. Ensure adequate fluid intake
Men should drink 2L fluids per day, women 1.6L.5
c. Increase activity and exercise levels, if needed
Step 3First-line treatment
If lifestyle measures (including changes to medication) have been ineffective, or symptoms do not respond adequately, oral laxatives may be recommended.
Consider bulk-forming laxatives (with plenty of fluids) as first-line treatment; for example, ispaghula husk, which is the active ingredient in products such as Fybogel. Bulk-forming laxatives are not recommended for customers with opioid-induced constipation.
Step 4Second-line treatment
Consider adding/switching to osmotic laxatives (for example, macrogol) if stools remain hard/difficult to pass.
If stools are soft, but the customer is still having trouble passing them, or the customer feels that their bowel isn't emptying, a stimulant laxative (for example, senna) can be added.
Once symptoms have resolved (i.e. producing soft, formed stools without straining, at least three times per week), gradually reduce and stop laxative use.
Test your knowledge
What would be your first step for a customer who presents with constipation for the first time if following the NICE CKS for short-term constipation?
Discuss dietary fibre intake and current medication use
Recommend a bulk-forming laxative
If a customer has tried changing their diet, and is not taking other medication, which laxative could you recommend at first, if following the NICE CKS?
Stimulant
Osmotic
Bulk-forming
Stool softener
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