How to Treat & Prevent Constipation in Palliative Care | Opioid-Induced Constipation

Описание: Constipation is a common but often overlooked symptom in palliative care and advanced organ illness. In this video, Dr. Jonathan Wong, a palliative care physician in Winnipeg, Canada, explains how constipation is treated and prevented in the context of advanced cancer, organ failure, and end-of-life care.

This video focuses on non-pharmacological strategies, laxative options, and a detailed discussion on opioid-induced constipation, including when and how stimulant laxatives, osmotic laxatives, and newer medications such as PAMORAs (peripherally acting mu-opioid receptor antagonists) may be used. You’ll learn how different treatments work, which options are often ineffective or poorly tolerated in palliative care, what to avoid (including fibre supplements in low-fluid states), and how bowel care goals must be individualized as illness progresses.

📌 This video covers:

What “normal” bowel function means in advanced illness

Non-drug approaches and their limitations in palliative care

Stimulant, osmotic, and stool-softening laxatives explained

Prevention and treatment of opioid-induced constipation

PAMORAs: how they work and when they may be appropriate

Emerging treatments on the horizon

#palliativecare #palliative #opioidinducedconstipation


If you haven't seen Part 1 of this series on constipation, here's a link:
   • Constipation in Palliative Care - Common C...  

00:00 Intro
00:55 Welcome & Disclosure
01:33 Goals and what is normal?
04:01 Diet & exercise, Non-pharmacological treatments
05:21 Psyllium supplements
06:28 Other non-pharmacological treatments
06:55 Complementary therapies
07:30 Pharmacological treatments, laxatives intro
08:08 Docusate
09:05 Stimulant laxatives
10:22 Osmotic laxatives
12:40 Rectal options
14:18 Opioid induced constipation - Treatments and prevention
16:01 PAMORAs
19:10 New options
19:55 Summary

About this channel:
Welcome to Palliative Care Explained - a channel aimed at answering your questions about palliative care and end of life care. My name is Dr. Jonathan Wong (MD, FRCPC) and I am a palliative care doctor based out of Winnipeg, Canada.
Brought online March 28, 2025, Palliative Care Explained is a channel aimed at answering your questions about palliative care. My formal medical training is in internal medicine and palliative care and I have been working in the field of palliative care since 2011. It is my hope that this channel will better inform viewers about palliative care, end of life care and living with a serious illness.

Intro music written & recorded by: Jonathan Wong

Committee advisors:
Dr. P. Daeninck MD, MSc, FRCPC
Dr. E. Giannouli MD, FRCPC
Dr. J. Strutinsky-Mason MD, MSc, MRCP (UK)

Disclaimer and medical-legal statements:
*As a medical professional speaking to you, I hereby declare that I do not have any conflicts of interest that would compromise the integrity of the presented information.
*I do not have any financial sponsors nor am I receiving any funding from the pharmaceutical industry.
*This channel and its production, is my own undertaking, with support from other palliative care experts.
*This video series is for educational purposes only and is intended for audiences in Canada.
*The presented information may not be applicable to all viewers.
*I am not providing any direct medical treatment or advice to the viewer.
*These videos are not meant to imply or establish a therapeutic relationship with the viewer.
*These videos are not to replace or subvert the advice from the viewer’s own doctor or health care provider team.
*Any further questions should be directed to the medical team most familiar with the viewer’s unique situation.



References and further reading:

Palliative Medicine – A Cased Based Manual
Fourth Edition
MacDonald S, Herx L, Boyle A
Copyright Oxford University Press 2022. Published by Oxford University Press.

Oxford Textbook of Palliative Medicine
Sixth Edition
Cherny N, Fallon M, Kaasa S, Portenoy R, Currow D.
Copyright Oxford University Press 2021. Published by Oxford University Press.

JAMA Evidence
Care at the close of life – Evidence and Experience
McPhee S, Winker M, Rabow M, Pantilat S, Markowitz A
Copyright American Medical Association 2011. Published by McGraw-Hill.