Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic constipation secondary to long-term opioid therapy. Reports decreased frequency of bowel movements (<3/week), straining, sensation of incomplete evacuation, and hard/lumpy stools (Bristol Stool Scale Type 1-2). Symptoms persist despite adequate hydration and fiber intake. No red flags (hematochezia, unintentional weight loss, or nocturnal symptoms).
Clinical Examination Findings
Abdominal examination reveals mild distension with generalized tenderness to deep palpation, primarily in the left lower quadrant. Bowel sounds are hypoactive. Digital rectal examination (DRE) confirms the presence of hard, impacted stool in the rectal vault; rectal tone is normal. No evidence of masses or fissures.
Treatment Protocol
Initiate PAMORA (Peripherally Acting Mu-Opioid Receptor Antagonist) therapy (e.g., Methylnaltrexone or Naloxegol) as indicated. Optimize osmotic laxative regimen (e.g., Polyethylene Glycol). Advise on titration of opioid dose if clinically feasible. Monitor for abdominal pain or diarrhea.