A 72-Year-Old Man Is Evaluated for Refractory Constipation

A 72-year-old man is evaluated for refractory constipation.  He recently had an episode of stool impaction requiring manual disimpaction and is now passing flatus and small amounts of hard stool.  He has no abdominal pain, vomiting, or hematochezia.  The patient is receiving palliative care for stage IV lung cancer with multiple skeletal metastases and has adequate pain control with a fentanyl patch and oral immediate-release morphine.  His other medications include a fiber supplement, senna-docusate combination, and oral lactulose.
Examination shows a frail-looking, cachectic man.  Bowel sounds are normal.  His abdomen is soft, nondistended, and nontender.
Which of the following is the most appropriate next step in managing this patient's constipation?

A) Add methylnaltrexone therapy
B) Administer mineral oil enema
C) Change morphine to hydromorphone
D) Discontinue fentanyl patch
E) Start misoprostol therapy

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free