What do they use in hospital for constipation?

October 12, 2025 •

4 min read

Up to 15% of ventilated patients in the Intensive Care Unit (ICU) experience constipation, and hospitalized patients in general are at high risk due to immobility, diet changes, and medications. Healthcare providers take a structured, escalating approach to determine what do they use in hospital for constipation, prioritizing patient comfort and safety with a variety of pharmacological and non-pharmacological interventions.

Quick Summary

This guide covers the medications and treatments used in hospitals to manage constipation. It explains different types of laxatives, rectal therapies, and specialized treatments for conditions like opioid-induced constipation, alongside non-medication strategies.

Key Points

Structured Approach: Hospitals use a multi-step approach, starting with less invasive treatments and escalating as needed based on patient response and condition.
Osmotic Laxatives are First-Line: Polyethylene glycol (PEG) is a preferred first-line osmotic agent due to its safety and efficacy in drawing water into the bowel.
Stimulants are Second-Line: Bisacodyl and senna are added if osmotic laxatives are insufficient, as they actively stimulate intestinal muscle contractions.
Opioid-Induced Constipation (OIC) Requires Special Treatment: Patients on opioids may need specialized medications like PAMORAs (e.g., methylnaltrexone) that specifically block opioid effects on the gut.
Rectal Therapies for Rapid Relief: Suppositories and enemas offer quick evacuation for lower bowel issues or fecal impaction.
Non-Pharmacological Care is Crucial: Increasing fluid intake, encouraging mobility, and promoting fiber are fundamental to a successful hospital bowel care regimen.
Severe Cases Require Aggressive Measures: Fecal impaction may necessitate manual disimpaction or high-volume bowel prep with polyethylene glycol.

Constipation is a common and often challenging issue for hospitalized patients, influenced by factors unique to the inpatient setting. Unlike at-home management, which relies heavily on diet and lifestyle, hospital care involves a tailored approach to prevent complications and restore normal bowel function efficiently. The strategy progresses from less invasive options to more aggressive interventions, with the ultimate goal of achieving one non-forced bowel movement every one to two days.

Understanding the Causes of Hospital-Acquired Constipation

Multiple factors contribute to constipation in a hospital environment, making a simple, one-size-fits-all solution ineffective. These contributing elements include:

Immobility: Bedridden or less mobile patients experience reduced gut motility.
Medications: Opioids for pain relief are a primary cause of constipation (opioid-induced constipation or OIC), but other medications like anticholinergics and calcium channel blockers also play a role.
Dietary Changes: Insufficient fiber and fluid intake are significant contributors.
Illness: Underlying medical conditions and electrolyte imbalances can impair normal bowel function.
Fear: Post-surgical patients may be reluctant to strain, further exacerbating the issue.

Pharmacological Treatments in Hospital Settings

Hospitals employ a range of medications, often in combination, to address constipation. These are generally categorized by their mechanism of action.

Osmotic Laxatives

These are often the first-line therapy. They work by drawing water into the intestinal lumen, which softens the stool and promotes bowel movement.

Polyethylene Glycol (PEG): Marketed under names like Miralax, PEG is a frontline agent known for being effective and well-tolerated with few side effects. For severe cases, larger volumes (e.g., GoLytely) may be used for rapid bowel cleansing.
Magnesium Hydroxide: Also known as Milk of Magnesia, it has a faster onset than PEG but is used cautiously in patients with renal impairment due to the risk of electrolyte disturbances.
Lactulose and Sorbitol: These poorly absorbed sugars also have an osmotic effect but are less favored than PEG because they can cause more gas and bloating.

Stimulant Laxatives

If osmotic agents are not effective alone, a stimulant may be added. These agents stimulate the muscles of the intestine to increase peristalsis, moving stool along more quickly.

Bisacodyl: Available as oral tablets and rectal suppositories, bisacodyl is a common second-line agent.
Senna: Often used in combination with other agents, senna is another widely used stimulant laxative.

Rectal Therapies and Enemas

For quicker relief or for patients with fecal impaction in the rectum, rectal administration is often necessary.

Suppositories: Glycerin or bisacodyl suppositories work quickly to promote a bowel movement, typically within minutes to an hour.
Enemas: Tap-water, phosphate (Fleet), or oil-retention enemas can be used to soften and evacuate stool from the lower bowel. They are used with caution in certain patient populations.

Specialized Therapies for Opioid-Induced Constipation (OIC)

For patients on long-term opioid pain management, standard laxatives may not be enough. OIC is caused by opioids binding to receptors in the gut. Specialized medications are used to counteract this effect without reversing the pain relief.

Peripherally Acting µ-Opioid Receptor Antagonists (PAMORAs): Drugs like methylnaltrexone, naloxegol, and naldemedine selectively block opioid receptors in the gut. Methylnaltrexone can be administered via subcutaneous injection for hospitalized patients unable to take oral medication.

Non-Pharmacological Management Strategies

In conjunction with medication, hospitals focus on lifestyle measures where possible to aid bowel function.

Hydration: Encouraging adequate fluid intake is foundational, as many medications work by drawing water into the bowel.
Mobility: Encouraging ambulation, or simply getting out of bed, helps stimulate intestinal motility.
Fiber: For patients able to tolerate it, fiber supplementation may be used, though its effect is not immediate and requires adequate fluid intake.

Addressing Severe Constipation and Fecal Impaction

In cases of severe, unresponsive constipation or diagnosed fecal impaction, more aggressive measures are employed.

Manual Disimpaction: For severe fecal impaction, healthcare providers may need to manually remove the hardened stool from the rectum.
High-Volume Bowel Cleansing: In cases of more proximal impaction, high-volume polyethylene glycol (GoLytely) can be administered orally or via nasogastric tube until the patient's rectal effluent is clear.

Comparison of Common Hospital Laxatives


Type	Example	Mechanism	Onset	Common Uses in Hospital
Osmotic	Polyethylene Glycol (PEG)	Draws water into colon to soften stool.	1–3 days (powder).	First-line treatment for uncomplicated constipation.
Osmotic	Magnesium Hydroxide	Osmotic retention of fluid.	30 min – 6 hrs.	Quick relief; caution in renal impairment.
Stimulant	Bisacodyl (Oral)	Stimulates intestinal muscles to contract.	6–12 hours.	Second-line, used with osmotics.
Stimulant	Bisacodyl (Suppository)	Stimulates rectal nerve endings.	15–60 minutes.	Rapid relief for distal impaction.

Conclusion

In a hospital setting, addressing constipation requires a systematic and stepped-care approach. Healthcare providers first address underlying causes like opioid use or immobility, while simultaneously initiating a bowel regimen. They start with osmotic agents, like polyethylene glycol, and may add stimulants or rectal therapies as needed. For severe cases like fecal impaction, specialized interventions are available. The tailored, multi-faceted strategy ensures effective and safe management, helping patients recover and get back to normal bowel function.

For more detailed information on specific drug interactions and indications, consult authoritative pharmacological resources such as the U.S. National Library of Medicine.(https://pmc.ncbi.nlm.nih.gov/articles/PMC10573544/)

Frequently Asked Questions

Constipation is common in hospitals due to patient immobility, dehydration, dietary changes, and medications. Opioids for pain relief are a frequent cause, as are anticholinergic drugs.

For immediate relief of constipation, especially if the problem is in the rectum, a rectal suppository (like bisacodyl) or an enema is the fastest option. These can produce a bowel movement in minutes to an hour.

PEG is a common first-line treatment for constipation in hospitals. It is an osmotic laxative that draws water into the colon to soften the stool, making it easier to pass. It is well-tolerated and effective.

PAMORAs (Peripherally Acting µ-Opioid Receptor Antagonists), such as methylnaltrexone, are specialized medications used to treat opioid-induced constipation (OIC). They block the constipating effects of opioids in the gut without interfering with pain relief.

According to some hospital protocols and research, docusate is considered largely ineffective for treating or preventing constipation, especially in critically ill patients. It is mainly a stool softener and lacks significant evidence of efficacy.

Fecal impaction requires more aggressive treatment. For impaction in the rectum, manual disimpaction by a healthcare provider may be necessary. For impaction higher in the bowel, a high-volume bowel cleanse with a solution like GoLytely is used.

While hydration and mobility are crucial components of any bowel regimen, they are often insufficient on their own in the hospital setting, especially for patients with severe illness or those on constipating medications. Pharmacological intervention is frequently necessary.