The patient has increased his fluid and dietary fiber intake and has started a supervised exercise program. However, he is still having problems with constipation. Which of the following would be an effective intervention? (Select all that apply.)
a. Metamucil
b. Milk of magnesia
c. Dulcolax
d. Mineral oil
e. Colace
A, B, C
Use the following stepwise levels of interventions. Bulk-forming laxatives (e.g., psyllium [Metamucil], methylcellulose [Citrucel]) are safe, add bulk to the fecal material, and are used in combination with a saline laxative (e.g., magnesium hydroxide [milk of magnesia]) or an osmotic laxative (e.g., lactulose [Chronulac]). The patient should increase water intake to enhance the effectiveness of bulk-forming laxatives. If constipation continues, stimulant laxatives (e.g., bisacodyl [Dulcolax], senna [Senokot]) usually provide relief. Avoid emollient laxatives, such as mineral oil and Colace, because they are associated with lipoid aspiration pneumonia.
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