5 - GI: Constipation Flashcards
What is Constipation?
Abnormally slow movement of feces through colon w/ accumalation
Straining to have stool
Dry / Hard / Small stools
Feelings of Incomplete bowel evacuation
BLOATING
Epidemiology of Constipation
WOMEN > men
no difference in age groups
Higher in > 65 y/o
Common in Pregnancy
Etiology of Constipation
-
Disease Induced
- Ulcers / Fissures / hemorroids
- gallbladder disease apppendicitis / ileitis
- hypothyroidism / diabetic neuropathy / CVA / MS / IBS / DVT
-
Drug Induced
- OPIATES + more
-
Psychogenic
- Depression / eating disorders
-
Lifestyle
- low calorie / carbs / fiber / inadequite fluid intake
Special Populations in Constipation
-
Older Adults >65 y/o
- Physiologic changes / meds / disease
-
Children
- emotions / febrile / dietary changes / POOR EATING habits
-
Women
- PREGNANCY / HORMONES
- IBS / slower gut transit times
- surgery after childbirth
Common Symptoms of Constipation
- Decreased Frequency of bowel movements
- Difficult Passage of HARD stool
- Anorexia
- Dull Headache
- Lassitude (lack of energy / awareness)
- Lower Back pain
- Abdominal Distention
EX-ST of Constipation
- SIGNIFICANT abdominal pain / distention / cramping
- Marked or unexplained flatulence
- FEVER + N/V
- Paraplegia / Quadriplegia
- Changes in bowel habits
-
Bloody / Dark / Tarry stools
- change in CALIBER o stool
- Symptoms perisiting fo_r_ >2 weeks or recur _over 3 month_s
- H/o of IBD
- Daily laxative use
Non-Pharmacologic Treatment
of Constipation
- Regular bowel habits
- Increase DIETARY INSOLUBLE FIBER
-
Wheat / grains / oats / fruits / veggies
- 14g/1000kcal
-
Wheat / grains / oats / fruits / veggies
- Increase WATER intake
- Avoid constipating foods
- Regular EXERCISE
- Stress management
Pharmacologic intervention if quicker relief is needed!
- Bulk forming Laxatives
- Lubricants / Emollient
- Stimulants
- Saline Laxatives
- Hyperosmotic Laxatives
Bulk-Forming Laxatives
Onset / Use
Metamucil / Fibercon
Psyllium / calcium polycarbophil / methylcellulose
Onset is 12-24 hours
Duration of <72 hours
Used for Treatment & Prevention of Constipation
Bulk-Forming Laxatives
ADR / DI / Counseling
Metamucil / Fibercon
Cramping / Flatulence
8oz of WATER Per dose!
obstruction if inadequate fluid intake
Tetracyclines
Seperate by 1-2 hours from all medications
Emollient Laxatives
Onset / Use
Colace = Docusate
Used for PREVENTION
Avoid STRAINING
surfactant = increase wetting / soften fecal mass
onset is 1-3 days
Emollient Laxatives
ADR / DI / Counseling
Colace / Docusate
Abdominal Pain / Diarrhea
MINERAL OIL
1-2 times a day w/ fluids
not for children <6 y/o
Saline Laxatives
Onset / Use
Milk of Magnesia
Mag citrate / MgOH2 / Fleet enema
Osmotics
used for TREATMENT / BOWEL PREP
Onset = 30min - 3 hours (orally)
<1 hour (rectally)
Saline Laxatives
ADR / DI / Counseling
Milk of Magnesia
N/V/D
Fluid/e- imbalance + Craming
Warfarin / Digoxin / TCA’s / SPS
- not for pts w/ :*
- ileostomy / colostomy / dehydration / renal impairment / CHF*
Stimulant Laxatives
Onset / Use
Senokot / Dulcolax
Sennosides / biscodyl / castor oil
Stimulate Peristalsis
used for TREATMENT / BOWEL PREP
Onset is 6-12 hours (orally)
15-60 minutes (rectally)
DNU for > 7 days
Stimulant Laxatives
ADR / DI / Counseling
Senokot / Dulcolax
DNU > 7 days
commonly abused
Cramping / Loss of normal bowel fxn
Fluid/e- imbalance
castor oil may induce LABOR
Hyperosmotic Laxative
Use / Onset
Miralax
PEG 3350 / Glycerin
Osmotic / Local irritant Effect (draws water into rectum)
Used for TREATMENT / PREVENTION / BOWEL PREP
Onset for glycerin is 30 min
onset for PEG = 1-3 Days
Hyperosmotic Laxative
ADR / DI / Counseling
Miralax
Bloating / Cramping
Abdominal discomfort / Flatulance
Caution in renal disease
Glycerin is just Cramping / irritation / burning
Glycerin Dose / Drug Type
Hyperosmotic Laxative
for constipation
Adult dose = 3g PR
Children < 6 y/o = 1g - 1.5g PR
cramping / irritation / burning
Recomended Laxatives for
Acute Treatment
Bulk Forming
Metamucil / Fibercon
Hyperosmotic Laxative
Miralax (PEG)
Stimulant
Senokot / Dulcolax (biscodyl)
Recommended Laxatives for
CHRONIC treatment
Fluids / Dietary Changes / Physical Activity
Bulk Forming
Metamucil / FiberCon
Occational Stimulants
Senokot / Dulcolax
Senakot + Senakot S
Dose / Indication
Sennosides +/- docusate
Stimulant Laxative +/- Emollient
8.6 mg +/- 50mg docusate
2 tabs (17.2) at bedtime
2nd dose may be given during the day
Senakot + Senakot S
CIP / DI
Sennosides +/- Docusate
Appendicitis / Ab pain / n/v
Rectal bleeding / Failure to bowel move
DNU >7 days
Senakot + Senakot S
ADR / Consult
Sennosides +/- Docusate
Electrolyte/fluid deficiency
hypoKALEMIA / loss of protein
Chest pain / Malabsorption
Ask why they need a laxative?
Bowel habits / appearance
RECTAL BLEEDING SEE MD
Try dietary fiber / fluid intake / exercise
