Bowel disorders Flashcards
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Outline constipation as a bowel disorders
- A change in bowel habit that results in no stools being passed for at least three days
- Slower bowel transit allows more water to be reabsorbed from faecal matter
- Stools become hard and difficult to pass
Outline what causes constipation
- Low fluid intake/ dehydration
- Lack of fibre
- Lack of exercise
- Changes in diet
- Pregnancy
- Medication
Outline signs and symptoms of contstipation
- Difficulty passing stools
- Pain when passing stools
- Hard/solid stools are more hard and solid
- Bloating or abdominal discomfort
Outline when to refer for constipation 1
- Children under 12
- Blood or mucus in stools
- Significant change in bowel habit
- Unexplained weight loss
Outline when to refer for constipation 2
- Long duration or symptoms (more than 1 week)
- Presence of pain, bloating and nausea
- OTC medication failure
- Prescribed medication known to cause constipation
Outline 1 type of treatment for constipation
Stimulant laxatives which stimulate nerve endings in the
bowel to promote the movement of the stools
- Usually effective in 8-12 hours;
- Suitable for short term use only
Outline the recommended dose for stimulat laxatives
Dulcolax 5mg tablets (bisacodyl)
* ONE to TWO tablets before bedtime
Dulcolax Adult Pico Liquid (sodium picosulphate 5mg/5mL)
* ONE to TWO 5mL spoonfuls before bedtime
Senokot 7.5mg tablets (Senna fruit)
* ONE to TWO tablets before bedtime
Senokot Max strength (Senna fruit)
* ONE 15mg tablet before bedtime
Outline concerns with stimulant laxatives
- Not for regular use
- Not for long term use
- Can affect bowel tone
- Often misused
Outline a 2nd treatment for constipation
- Bulk forming laxatives which contain natural fibre and
increase the mass of the stools,
encouraging the intestine to
move faster(HOLD WATER IN STOOLS) - Usually effective in 24-36 hours;
Outline the recommended dose for bulk forming laxatives
Fybogel Hi-fibre (ispaghula husk)
* Take one sachet in the morning and one in the evening.
* Take at least two hours before going to bed
Other bulk forming laxatives include Methylcellulose
Outline concerns with bulk forming laxatives
Taste and texture are challenging
* not suitable for patients with impaction, obstruction or atonic bowel
* Not for use in patients with alternating bowel habit
* Not suitable for patients with difficulty swallowing
* Has been known to cause rashes and itching to some patients
Outline a 3rd treatment for constipation
- Osmotic laxatives which increase the
amount of water in the large
bowel - Increase stool volume prompting
a bowel movement - Usually takes 24-48 hours to
work - e.g. Movicol and Lactulose
Outline the recommended dose for osmotic laxatives
Movicol Sachets (Macrogol 3350, Sodium chloride, Sodium bicarbonate, Potassium chloride)
* 1-3 sachets daily in divided doses
Lactulose Oral Solution (Lactulose 3.3g/5ml).
* 15-45ml either once daily or split in two divided doses
Outline concers with osmotic laxatives
- Cost
- Taste
- Bulky
- Can cause diarrhoea if misused
HOWEVER SAFE FOR PREGNANCY
Outline a 4th treatment option for constipation
- Faecal Softeners act by adding water to faecal
matter, their other mode of action appears to be reducing surface
tension - Glycerin appears to have some softening effect
- Oil based softeners appear to primarily have a lubricating effect
- Making them easier to pass
- E.g docusate sodium, glycerin, paraffin
Outline the recommended dose for faecal softeners
Docusate Docusate sodium 100mg capsules
Take 1 capsule 3 times a day , increase to 5 times a day if necessary
* Glycerol (4g glycerol suppository)
* One to be inserted rectally as required
* Liquid Paraffin
* Two to six 5mL spoonfuls when required
Outline concerns of faecal softeners
Docusate Sodium
* Takes a few days to work
* Can cause nausea, diarrhoea, cramps and rashes/itching
Glycerol
* requires rectal insertion, not popular
* Can cause cramps, irritation and wind
Liquid paraffin
* is potentially dangerous, can cause pneumonia if inhaled
* Causes vitamin deficiency with repeated use
Outline lifestyle advice for constipation
- Drink plenty of fluids
- Increase dietary fibre intake
- Improve toilet routine
- Increase exercise or activity
Outline diarrhoea as a bwoel disorder
- An increase in bowel movements involving loose or watery stools
- When the lining of the large intestine becomes inflamed, insufficient fluid is removed from the food in the intestine.
- Stools then become looser/liquid-like when they are excreted from
the body - Can lead to dehydration
Outline what causes diarrhoea
- Bacterial or viral infections (gastroenteritis)
- Dietary changes
- Food allergies and food poisoning
- Alcohol in excess
- Poor hand hygiene (faecal-oral route)
- IBS
Outline signs and symptoms of diarrhoea
- Increased frequency of stools
- Loose or liquid-like stools
- Abdominal cramps
- Bloating
- Nausea and vomiting
- Increased urgency to pass stools
- Flatulence
Outline when to refer for diarrhoea
- Children under 12
- 1 day duration in under 1s
- 2 days duration in under 3s and elderly
- Symptoms persisting for 3 days or more in others or recurrent
- If patient shows signs of dehydration
- Diarrhoea accompanied by fever or severe nausea and vomiting
- Anyone returning from holiday abroad
- Blood in stools
Outline 1 treatment option for diarrhoea
Rehydration Salts
* Replaces lost fluids and
electrolytes (salts)
* Reduces risk of severe
dehydration
* Dehydration is a significant risk
in babies and children
* E.g dioralyte
Outline the recommended dose for dioralyte
Dioralyte sachets
* One to be taken immediately in approximately 200mL of water and drink
immediately
* To be taken after every loose motion (Poo!)
Dioralyte Relief sachets (Pre-Cooked Rice Powder 6G, Sodium Citrate 580Mg, Sodium Chloride
350Mg And Potassium Chloride 300Mg.)
* One sachet after each loose motion (watery stool) up to a maximum of 5
sachets per day for 3-4 days.
Outline concerns with rehydration salts
- Managing patient expectations
- Taste
- Requirement to reconstitute as instructed
- Young children still need to see a doctor
Outline a 2nd treatment option for diarrohea
- Antidiarrhoeals or Antimotility Agents which stop stools from being passed by
slowing bowel movement and
allowing fluids to be reabsorbed - Very effective treatment but not
without risk - E.g. loperamide, kaolin and
morphine
Outline the recommended dose for antidiarrhoeals
Imodium (Loperamide 2mg capsule)
* Take 2 capsules to start treatment. Take 1 capsule after each loose bowel
movement, up to a maximum of 6 capsules per day.
Imodium Plus
* Take TWO caplets immediately. Then take one caplet after each loose bowel
movement.
Kaolin and Morphine
* Shake the bottle, Mix 2 teaspoons (10ml) of the medicine in water and
consume. Repeat this dose up to 3 times a day if required.
Outline concerns of antidiarrhoeals
- May simply delay seeking medical advice
- may hide symptoms of infection
- Not suitable for children under 12
- Kaolin and morphine has a potential for abuse
Outline lifestyle advice for diarrhoea
- Stay at home and get plenty of rest
- Stay off school/work until you have not had diarrhoea for at least 2
days to reduce spread of bacterial infection - Small frequent sips of fluids (water/squash)
- Eat when you are able to
- Effective handwashing would have the most significant impact
Outline Irritable bowel syndrom as a bowel disorder
- Common long term bowel condition that affects bowel function with
associated symptoms and pain which is intermittent. - It affects up to 20% of the population.
- Common in women but cause unknown
Outline what causes IBS
MaAIN SYMPTOMS
* Abdominal pain
* Abdominal distension
* Disturbed bowel habit
OTHER SYMPTOMPS
* Nausea
* Lethargy
* Urinary symptoms
Outline when to refer for IBS
- Children
- Older people with recent onset
- Pregnancy
- Blood in stools
- Unexplained weight loss
- Unresponsive to treatment
- Not previously diagnosed
Outline a treatment option for IBS
- Antispasmodics which work on smooth muscle within
the gastrointestinal tract to relax
muscle and reduce pain from
spasm - side effects are relatively rare
- E.g. peppermint oil, mebeverine
- hyoscine
Outline the recommended dose for Antispasmodics
Colpermin (peppermint oil 0.2% capsules)
* One capsule three times a day. This dosage may be increased to two
capsules three times a day if discomfort is severe.
Buscopan (hyoscine 10mg tablets)
* The recommended starting dose is 1 tablet three times daily; this can
be increased up to 2 tablets four times daily if necessary.
Colofac IBS (mebeverine 135mg tablets)
* One tablet three times a day, preferably 20 minutes before meals.
Outline safety concerns of antispasmodics
- Only work for spasm symptoms no direct effect on bowel movement symptoms
- Require diagnosis first so some patients may be disappointed
- Colpermin not suitable for nut allergy suffers
- Can cause skin reactions and swelling
- Hyoscine can also cause dry mouth and allergic response
- No children
Outline lifestyle advice for IBS
- Relaxation techniques might be beneficial
- Some alternative therapies might also be of benefit.
- Following a low fat, low sugar, high fibre diet
- Adding bran to the diet
- Avoid certain sweeteners
- Identifying aggravating factors
- Some patients benefit from a reduction in caffeine intake
