66: Constipation Flashcards
Constipation
-dec freq
-disorder of motility and rectal function
-cramping, bloating
-hard dry stools
-straining, blockage
Gi transit time
-mouth to anus
-30-40 hours
-upto 72 hours can still be normal tho
movement of water in and out of stool
-more time for colon to absorb water from waste
-results in stool becoming hard and difficult to push out
Acute constipation
-noticeable change in normal bowel movement pattern
-less than 3/week
-dry, hard stools
-painful movements
-hard to pass stool
-brought on by change in condition or drug
Chronic constipation
-more than 6 weeks
-may respond to lax but it comes back
-does not respond to diet
Common causes of chronic constipation
-dietary (poor fluid/calorie intake)
-failure to heed defecation reflex
-impaired physical mobility
-lack of privacy
-inc distress
Disease states that slow GI motility
-diabetes
-parkinsons
-CNS probs
-MS
-constipation
Common drug causes of constipation
-opioids
-NSAIDs
-Antacids
-strong anticholinergics
-iron
-vearpamil, clonidine, Ca channel blockers
-diuretics
-chronic use of stimulant lax
Refer constipated pt if
-symptoms >2weeks
-black/tarry stool
-ab bain or discomfort
-fever
-severe N/V
-family history of IBD or colon cancer
-drastic change in symptoms
Measures to promote bowel movements
-ample fluids and fiber (add slowly)
-6-8 glasses of water per day
-prunes, kiwi, psyllium
-do not ignore urge to defecate
-poop first thing in the AM and within 30 min after meals
Dietary fiber
-add slowly over 7-10days to minimize gas
-20-30g/day
-veggies, fruits, beans, whole grains
Prunes
-sorbitol
-12g fiber
-dihydrophenylsatin (natural lax)
Bulk lax products
-psyllium (Metamucil)
-Methylcellulose (citrucel)
-Calcium polycarbophil (Fibercon)
Bulk lax moa
-forms emmolient gels that retain water
-swells and stimulates BM
Bulk lax pros
-soften stool better than DOCUSATE
-few side effects
bulk lax disadvantages
-taste
-must drink enough fluids
-gas
-impact on drug absorption
-not ideal if beddridden
Bulk lax admin
-mix citrucel w at least 8 oz cold water
-drink immediately
-produce less gas
Surfactant / Emoillient product
-Docusate (DOSS) 100mg qd or bid
Docusate
-surfactant/emmolient lax
-100mg qd or bid
-helps prevent hard stools (hemorrhoids)
-NOT effective for active constipation
Lubricant product for constipation
-Mineral Oil
Mineral oil
-lubricant for constipation
-30-60mL qd
-lubricates lumen and softens stool
mineral oil disadvantages
-oily
-only effective in PREVENTION of constipation
-may dec absorption of fat-soluble vitamins
Saline laxative products
-MOM
-Mg Citrate
-Saline Enema (rapid onset)