constipation Flashcards
what is constipation?
when theres a reduction in normal bowel habit with more difficult defaecation and harder stools. occurs when large intestine reabsorbs more water than normal back into the bloodstream.
symptoms of constipation
abdominal discomfort, bloating, specks of blood due to straining.
causes of constipation
lack of fibre in diet,insufficient food intake, insufficient fluid intake, avoiding defaecation due to pain ( common in children), ignoring urge to defecate, lack of exercise, pregnancy, medications and ageing.
referral criteria for constipation
substancial blood loss, black and tarry stools, under 8, sudden change in bowel habits, pregnant women, longer than 7 days, other medications, no success of treatment after 5 days,frail or elderly,repeated abuse of laxatives
what is the purpose of stimulant laxatives?
they encourage bowel movements by acting directly on the wall of the intestine and stimulating peristalsis ( contractions of gi tract and organs).
how long do stimulant laxatives take to work?
between 8-12 hours so should be taken at night for expected bowel movements in the morning.
cautions for using stimulant laxatives?
long term use can lead to nerve damage and a lazy bowel. should be avoided in pregnancy as can cause contractions and it can cause gripping pain in abdomen.
types of stimulant laxatives
senna, bisacodyl, sodium picosulphate and glyceryl suppositories.
what is senna and the restrictions around use?
a natural stimulant laxative which provides a comfortable and predictable approach. its available as a syrup, tablets or granules and the usual starting dose is 7.5mg at night. its suitable for 12+
what is bisacodyl and the restrictions around use?
available as tablets or suppositories and recommended for over 10. can produce very thin and watery stools within 6-12 hours so recommended at night.
what is sodium picosulphate and the restrictions around use?
available as a liquid and and a solid form. can be given to 4+ on advice of a doctor
what are glyceryl suppositories and the restrictions around use?
effects can take place in 15-30 minutes. 1g for infants, 2g for children and 4g for adults. should be moistened before insertion.
what is the purpose of bulk forming laxatives?
increases volume of stool making it softer and easier to pass. patients should be advised to drink around 2l a day while taking.
how long do bulk forming laxatives take to work?
effects are usually seen in 12-36 hours although could take longer.
cautions around bulk forming laxatives?
gas, bloating and abdominal discomfort
types of bulk forming laxatives
iphagula husk, sterculia
what is iphagula husk and the restrictions around use?
available as granules and powders taken with water. availale for 6+
what is sterculia and restrictions around use?
available as granules placed in mouth and swallowed with water, can be sprinkled over food. available for 6+
what is the purpose of osmotic laxatives?
osmotic laxatives turns the contents of the intestines into a stronger solution so it moves out the blood and into the gut so more water can pass through.
types of osmotic laxatives?
lactulose, macrogol, magnesium salts
what is lactulose?
concentrated sugar solution given twice daily. safe for children and usually takes 48 hours for full effects but can cause wind and abdominal cramps.
what is macrogol and the restrictions around use?
polyethylene glycols are larger polymer molecules which combine with water keeping water in the bowel for longer. suitable for 12+
what are magnesium salts and restrictions around use?
turns intestinal contents into a very strong solution causing water to move in the gut. can cause gas, bloating and abdominal pain and is not suitable for children.
types of stool softeners
ducosate sodium
what is ducosate sodium and the restrictions around use?
works by allowing fluid from the intestine to penetrate into the stool. also has some stimulant properties. only suitable for 12+
what are the signs of laxative abuse?
very thin, pale clammy skin, dry and brittle hair, buying large amounts, dark circles around sunken eyes and malnourished appearance.
