# Constipation (acute and chronic) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Guideline ES35 (2017) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph) · Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65) - Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897) - Constipation - disease-level clinical article (constipation-full.txt) ## Treatment metadata - Lactulose — oral.liquid - Referral & safety-netting (no drug therapy) - Macrogol 3350 — oral.liquid - Bisacodyl — 5 mg — oral.solid - Glycerin — rectal ## Complete treatment card ```text CONSTIPATION (ACUTE AND CHRONIC) Sources: NICE Guideline ES35 (2017) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph) · Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897) Review status: REVIEWED against Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph), Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph), Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65), Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897), Constipation - disease-level clinical article (constipation-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (10) - Altered day-to-day bowel pattern compared with the patient's usual habit, such as missing a day - Patient describes the stools as hard - Straining with bowel movements - Sense of incomplete rectal emptying - Needing to manually remove stool from the rectum - Painful defecation reported in a child - Blood seen on the stool or on toilet paper - Soiling that can be mistaken for diarrhea [diarrhoea · faecal incontinence] - Inability to pass gas (flatus) [flatulence] - Unexplained weight loss [weight loss] SIGNS - what you find (7) - Abdominal distention, altered bowel sounds, tenderness, or a palpable mass [abdominal distension] - Rectal exam may reveal a mass, hemorrhoids, fissures, prolapse, or hard stool in the ampulla [haemorrhoids] - Fecal soiling evident on examination [faecal incontinence] - Bloody diarrhea in a constipated infant raises concern for Hirschsprung disease [bloody diarrhoea · constipation · diarrhoea] - A palpable lower-abdominal mass may be felt in a child [abdominal mass] - Impacted stool or an intrarectal mass found on rectal exam in children - Anal inspection checks the size and position of the anus and looks for rectal prolapse [rectal prolapse] TESTS (11) - CBC may show anemia from chronic rectal bleeding - Fecal occult blood testing to rule out an obstructing colon neoplasm - Elevated white cell count with fever or abdominal pain may point to underlying ileus - TSH is checked to rule out hypothyroidism when constipation resists dietary management - A metabolic panel may reveal hypokalemia or hypercalcemia as a cause - Plain abdominal x-ray can show fecal loading in the colon - Abdominal CT can establish the diagnosis of an intra-abdominal abscess - An empty rectal vault with a dilated proximal colon on imaging suggests large bowel obstruction - Anorectal manometry assesses motor and sensory function of the anorectum - Colonic transit studies use radiopaque markers to time how fast stool moves through the gut - Defecography can show an anorectal angle change, transient prolapse, intussusception, or pelvic floor weakness IF NOT THIS - what else fits (10) - Colorectal cancer is on the differential list for constipation - Hirschsprung disease is a differential, particularly relevant in infants - Hypothyroidism is a recognized cause of constipation to rule out - Irritable bowel syndrome is on the differential for chronic constipation - Crohn disease can present with constipation and must be distinguished - Rectal prolapse is a differential to look for on rectal exam - Rectocele is included in the differential list - Toxic megacolon must be considered among the differentials - Cystic fibrosis should be considered as a cause of constipation in children - Cow's milk protein allergy is a pediatric differential for constipation Source StatPearls "Constipation" - disease-level clinical article Status traced to the source above Rx: Main treatment | Oral stimulant | Rectal - fast relief MAIN TREATMENT - choose one 1. LACTULOSE [1st line] Adult 15-30 mL daily in 1-2 divided doses, adjust to produce soft stool - Short-term or chronic under supervision Peds Under 1 year: Up to 5 mL daily 1 to 6 years: 5 to 10 mL daily 7 to 14 years: 15 mL daily to start, then 10 to 15 mL daily. Adjust to produce a soft stool without diarrhoea. (Infant under 1 year: up to 5 mL daily. Child 1-6 years: 5-10 mL daily. Child 7-14 years: start 15 mL daily, maintenance 10-15 mL daily. Adjust to produce a soft stool without diarrhoea.) Choice Lactulose is the first choice here; polyethylene glycol is a further option. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) Why Safe first-line osmotic laxative suitable for all age groups Caution Takes 48 hours to act; advise patient not to exceed recommended dose prematurely. Caution in lactose intolerance or galactosemia. Maintain adequate hydration. Gastrointestinal obstruction. Digestive-perforation or risk of digestive perforation. Egypt FARCOLAC 667GM/L SYRUP 120 ML PHARCO 7.50 EGP LACTOLINE 50% SYRUP 200ML ALEXANDRIA 9.25 EGP LAEVOLAC 67GM/100ML SYRUP 120 ML SIGMA > FRESE... 12.00 EGP SEDALAC 3.35GM/5ML SYRUP 120ML SEDICO 20.00 EGP LAXOLAC 3.35GM/5ML SYRUP 300ML MUP 40.00 EGP LAXOLAC 3.35GM/5ML SYRUP 120ML MUP 50.00 EGP DUPHALAC 667GM/L SYRUP 200ML ABBOTT LABORA... 143.00 EGP LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320ML AUG PHARMA 170.00 EGP VILLAPURG 67% SYRUP 120 ML AL ESRAA PHAR... 12.00 EGP -> ? strength differs, ? different route - not oral liquid VILLAPURG 67% SYRUP 200 ML AL ESRAA PHAR... 17.75 EGP -> ? strength differs, ? different route - not oral liquid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Constipation - disease-level clinical article (constipation-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Look for alarm features and concerning historical features in the evaluation of constipation. 3. MACROGOL 3350 [1st line] Adult 1-3 sachets daily in divided doses, adjusted up or down as required to produce regular soft stools (maximum 4 sachets a day) - the 13.125 g adult sachet Peds 2 to 6 years: 1 sachet daily to start - the 6.563 g paediatric sachet, not the adult one 7 to 11 years: 2 sachets daily - the 6.563 g paediatric sachet, not the adult one (Child 2-6 yrs: starting dose 1 sachet daily; Child 7-11 yrs: 2 sachets daily - the 6.563 g paediatric sachet, not the adult one. Adjust to produce regular soft stools.) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65) Why First-line osmotic laxative recommended for maintenance treatment and disimpaction in chronic constipation. Caution Not recommended in children under 2 years of age for chronic constipation. Ensure adequate hydration during treatment. The sachet sizes are not interchangeable, and the doses above are counted in sachets. ENDF verbatim: "Products containing 6.563 grams per sachet: 1. For the treatment of chronic constipation in children 2 to 11 years of age" and "Products containing 13.125 grams per sachet: 4. Treatment of chronic constipation in adults". MOVICOL PAEDIATRIC is the 6.563 g sachet; MOVICOL is the 13.125 g one. Handing an adult pack to a child dosed at 1 sachet daily doubles it. NOT the colonoscopy preparation, which is the same drug at eight times the pouch. ENDF verbatim: "Products containing 100 grams per pouch: 5. Osmotic laxative indicated for cleansing of the colon in preparation for colonoscopy in adults". MOVIPREP and PREPAWEST are that product, and they are deliberately not among the Egyptian brands listed below. Egypt MOVICOL PAEDIATRIC 30 SACHETS NORGINE LIMIT... 221.00 EGP -> ! also contains potassium chloride, sodium chloride, sodium hydrogen carbonate MOVICOL 20 SACHETS NORGINE LIMIT... 273.00 EGP -> ! also contains potassium chloride, sodium bicarbonate, sodium chloride ORAL STIMULANT 4. BISACODYL [2nd line] Adult 5-10 mg once daily at bedtime (acts in 6-12 hours) - Up to 5 days without medical advice Peds Over 12 years: 5 to 10 mg once daily before bedtime (Children over 12 years: 5 - 10 mg once daily before bedtime.) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph) Why Stimulant laxative for short-term relief of acute constipation Caution CONTRAINDICATED in intestinal obstruction or acute surgical abdomen. Do not take within 1 hour of antacids or milk (dissolves enteric coating). Avoid prolonged continuous use due to risk of intestinal atony and electrolyte loss. Acute inflammatory bowel diseases. Patients with severe dehydration. Egypt CONSTACODYL 5 MG 10 ENTERIC COATED TAB. SIGMA 2.25 EGP DULCOLAX 5MG 20 SUGAR COATED TAB.. CID > SANOFI 3.00 EGP ABILAXINE 5 MG 20 COATED TAB. GLAXO SMITHKLINE 4.50 EGP BISADYL 5 MG 30 E.C.TABS. AMRIYA 28.50 EGP BISADYL 10MG/37ML ENEMA AMRIYA 6.00 EGP -> ? strength differs, ? different route - not oral solid RECTAL - FAST RELIEF 5. GLYCERIN [2nd line] Adult 1 suppository (4 g adult size) inserted rectally as required - Single use / as required Peds Children: One suppository (1.4 gm) rectally as needed. Infants: One suppository (0.7 gm) rectally as needed. Source Glycerin Suppositories BP 4 g Adult SmPC sections 4.2-4.3 (eMC product 4897) Why Fast-acting rectal lubricant/stimulant laxative (acts in 15-30 minutes) Caution Moisten suppository with water before insertion. Avoid in presence of anal fissures or severe proctitis. Dip the suppository in water before inserting it - dry glycerol drags and stings. The three sizes are separate products, not fractions of each other: 4 g adult, 2 g child, 1 g infant. The adult suppository is explicitly not for a child. Glycerin is for short-term rectal evacuation only. Egypt GLYCERIN ADULT 6 SUPP. (EL-NILE) EL NILE. 11.00 EGP (1.83/unit) GLYCERIN INFANTILE 10 SUPP. (GLAXO) GLAXO SMITHKLINE 19.00 EGP (1.90/unit) GLYCERIN ADULT 10 SUPP. (GLAXO) SMITHKLINE BE... 22.00 EGP (2.20/unit) GLYCERIN INFANTILE 6 SUPP. (EL-NILE) EL NILE. 14.00 EGP (2.33/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)