[19] Constipation Flashcards
Why is constipation difficult to define?
As it is a subjective experience
What generally suggests constipation?
Defecation less than 3x per week
What are the possible features of constipation?
- Straining
- Lumpy or hard stools
- Sensation of complete evacuation
- Sensation of anorectal obstruction/blockage
- Less than 3 defecations per week
Are loose stools a common feature of constipation?
Not without laxatives
Why is constipation an important symptom to consider?
Without treatment, can cause unnecessary suffering
What can cause constipation in cancer?
- Cancer treatments
- The cancer itself
- Side effects from other medications
- Insufficient fibre
- Insufficient fluids
- Lack of exercise
- Long term use of laxatives
- Ignoring the call to stool
- Depression and anxiety
- Other medical conditions
What aspects of cancer treatment can cause constipation?
- Chemotherapy or targeted drugs
- Abdominal surgery
Why can chemotherapy/targeted drugs cause constipation?
They affect the nerve supply to the bowel
What factors can cause constipation after abdominal surgery?
- Muscles may be too weak to expel stool
- Pain may make patient unable to expel stool
- Drugs for anaesthetic or for pain
- NBM
- Major pelvic operations can damage nerves that help bowel work properly
How can the cancer itself cause constipation?
- Press on nerves of spinal cord, slowing down or stopping movement of bowel
- Abdominal tumours can distort the bowel
- Tumour in lining of bowel can affect nerve supply to muscles
What are the most common medications that have constipation as a side effect in cancer?
- Painkillers, especially opioids
- Anti-emetics
What other medications can cause constipation?
- Some BP medications
- Antidepressants
- Vitamin supplements, such as iron and calcium
- Anti-convulsants
- Drugs for Parkinsons disease
- Diuretics
- Antacids
What medical conditions can cause constipation?
- Bowel obstruction
- Parkinson’s disease
- Spinal cord injiry
- Diabetes
- Hyper calcaemia
- Multiple sclerosis
- Thyroid problems
- Stroke
- Hypokalaemia
What should the history for constipation in cancer include?
- Full assessment of pre-disease and current bowel pattern
- Experience of defecation - difficulty, effort, outcome
- Stool itself
What information about the stool should be obtained in constipation?
- Type
- Consistency
- Colour
- Odour