Constipation Flashcards
Rome IV diagnostic criteria for constipation?
Spontaneous bowel motions occuring < 3 times week
Self-management advice for constipation? (3)
Gradually increase fibre intake (aiming 30g/day)
Maintain adequate fluid intake
Encourage exercise
Example of bulk-forming laxatives?
Ispaghula husk (e.g. fybogel)
Adverse effects of bulk-forming laxatives?
Flatulence, bloating, cramping, intestinal obstruction if inadequate fluid intake
Examples of stimulant laxatives? (3)
Bisacodyl
Senna
Docusate sodium (also acts as a softener)
Examples of faecal softeners? (2)
Docusate sodium
Glycerol suppositories
Examples of osmotic laxatives? (2)
Lactulose
Macrogols e.g. laxido
Management of short-term constipation? (3)
1st line- bulk-forming e.g. ispaghula husk
Add or switch to osmotic laxative e.g. macrogol/lactulose
Add stimulant laxative if stools are soft but difficult to pass/inadequate emptying
Management options for opioid-induced constipation? (2)
Avoid bulk-forming; offer osmotic + stimulant
Naloxegol if above ineffective
When can prucalopride be offered?
If two laxatives from different classes have been tried at the highest tolerated doses for at least 6 months and failurde to relieve symptoms, and where invasive treatment (e.g. suppositories, enemas) is being considered
Management of faecal loading/impaction? (3)
Hard stools- high dose oral macrogol
Soft stools- add oral stimulant laxative
Consider suppository/enema
How to step down laxative treatment?
Withdraw gradually, ideally stimulant laxatives first, once regular bowel motions with soft formed stools
When should patients with constipation be considered for suspected cancer referral?
If over 60 (change in bowel habit)
If under 60 and rectal bleeding + change in bowel habit
