Chapter 15: Constipation

Question 1

when evaluating a patient with constipation, what are the steps involved?

Answer 1

• determine cause of constipation (food/drugs)
• if prescription drug induced, contact Dr
• if likely caused by food, recommend high fluid-fiber intake and inc exercise if needed
• if fluid/fiber isn’t working, recommend a bulk former or hyper-osmotic
• if OTC products don’t work, see Dr

Question 2

exclusions for self-treatment of constipation:

Answer 2

• notable abdominal pain or unexplained flatulence
• fever
• nausea/vomiting
• chronic medical condition
• laxative use
• changes in bowel habits and weight loss
• bloody/dark stool
• symptoms persisting over 2 weeks or recur within 3 months
• anorexia
• under 2 years old

Question 3

bulk-forming agents (aka fiber supps.) should not be used in children under?

Answer 3

6

Question 4

what are the names of OTC bulk-forming agents?

Answer 4

methylcellulose
calcium polycarbophil
psyllium

Question 5

what are the names of OTC hyperosmotic agents?

Answer 5

Polyethylene glycol 3350 (PEG)

glycerin

Question 6

Polyethylene glycol 3350 (PEG) comes in what dosing strength?
children under what age should not use?

Answer 6

17g

17

Question 7

how is glycerin used?

Answer 7

rectally

Question 8

what are the names of OTC emollient agents?

Answer 8

docusate sodium

docusate calcium

Question 9

what is the daily dosing range of docusate sodium?

Answer 9

50-300mg

Question 10

what is the daily dosing range of docusate calcium?

children under what age should not use?

Answer 10

1 capsule (240mg) 
12

Question 11

what is the name of the lubricant agent?

Answer 11

mineral oil

Question 12

what are the names of the saline laxative agents?

Answer 12

magnesium citrate
magnesium hydroxide
magnesium sulfate
monobasic sodium phosphate/ dibasic sodium phosphate

Question 13

what are the names of the stimulant agents?

Answer 13

senna
bisacodyl
castor oil

Question 14

what dose does senna come in?

daily dose?

Answer 14

8.6mg tabs

2 tabs once or twice daily

Question 15

what dose does bisacodyl come in?

daily dose?

Answer 15

5mg tabs

1-3 tabs qd

Question 16

Bulk-Forming Agents:
onset of action
common adverse effects

Answer 16

12-72 hours

abdominal cramping and flatulence

Question 17

why should you take bulk-forming laxatives with plenty of water?

Answer 17

could get stuck in throat and when they swell up could cause choking

Question 18

how do hyperosmotic agents work?

Answer 18

draw water into colon or rectum to stimulate bowel movement

Question 19

common adverse effects of hyperosmotic agents?

Answer 19

bloating, abdominal discomfort, cramping, and flatulence

Question 20

how do emollients (stool softeners) work?

Answer 20

increase wetting efficiency of intestinal fluid to soften fecal mass

Question 21

common adverse effects of emollients?

Answer 21

none unless using more than recommended

Question 22

common adverse effects of saline laxatives?

Answer 22

abdominal cramping, nausea, vomiting, or dehydration

Question 23

how to prevent dehydration from saline laxatives?

Answer 23

take with 8oz of water

Question 24

how do stimulant laxatives work?

Answer 24

increase intestinal motility and increase secretion of water and electrolytes in intestine

Question 25

separate bulk-forming laxatives with other medications by at least _ hours due to drug absorption interferance

Answer 25

2

Question 26

do not use docusate salts with what other laxative due to increasing its absorption?

Answer 26

mineral oil

Question 27

do not mix bisacodyl with?

Answer 27

milk or PPIs

Question 28

how to insert an enema:

Answer 28

• if administered by someone else, like on left-side with knees bent or go into the knee-to-chest position
• if you are administering, like on back and bring knees to chest and raise your buttocks.
• make sure enema tip is lubricated and the anal area as well
• gently insert 2-3 inches into rectum
• allow solution to flow into rectum slowly and retain it inside rectum for 1-5 minutes

Question 29

how to insert a suppository:

Answer 29

• make sure it is firm enough to insert and cool it down
• unwrap it and dip into lukewarm water for a few seconds
• loe on left side with knees bent or go into the knee-to-chest position
• relax buttocks before inserting and then insert
• continue to lie down for a few minutes while holding the buttocks together
• avoid a bowel movement for roughly an hour after insertion

Question 30

what are some complementary therapies for constipation?

Answer 30

flaxseed, aloe, cascara, and probiotics