Constipation Flashcards
Constipation Symptoms
- Small hard stools passed less frequently than normal (NICE: less than 3 times per week)
- Straining
- Incomplete emptying
- Abdominal cramps/Bloating
- Nausea
When to refer constipation? What meds cause constipation?
- Blood in stools (black, tarry - upper GI bleed?) (Bright red - anal fissure, haemorrhoid)
- Unexplained weight loss, appetite loss (Colorectal cancer?)
- Patients over 40 years with sudden change in bowel habit (colorectal cancer?)
- Medication ADR (Opioids, Iron, TCAs, SSRI, Antimuscarinics, Diuretics, Aluminium antacids, Verapamil, Antihistamines)
- Lethargy, weight gain, coarse thinning hair, dry skin (hypothyroidism?)
- Stimulant laxative abuse (lazy bowel syndrome - misused for weight loss)
- Obstruction = Vomiting, abdominal distension and colic pain
- Constipation > 2 weeks (unless previously diagnosed)
OTC for constipation
1st line - Lifestyle advice
2nd - BOSS laxatives
Bulkforming
Osmotic
Stimulant
Stool softeners
What questions to ask for constipation?
Pregnant, Elderly, How urgent, Stool properties, Taking opioids, Tolerate side effects
What laxative is Ispaghula Husk (Fybogel)? What age to use?
Bulk forming, 6+
What laxative is Sterculia (Normacol)?
Bulk forming, 6+
What laxative is Methycellulose (Celevac)?
Bulk forming,
What are bulk forming laxatives used for?
How do they work? When full effect?
Side Effects?
Counselling?
1st line after lifestyle advice
Ideal for small, hard stools and fiber-deficient diets
- Increases faecal mass, works within 24 hours but 2-3 days for full effect
- Side Effect: Oesophageal or intestinal obstruction, Abdominal distension and flatulence
- Counsel: Swallow with water and not immediately before bed. Maintain adequate fluid intake.
- Ispagula (Fybogel) 6+
- Stercula (Normacol) 6+
- Methycellulose (Celevac)
What is macrogol? What age?
Osmotic laxative 12+
2-11 = Movicol
What is Lactulose? What age?
Osmotic laxative, 3 months +
What is magnesium sulphate (Epsom salts)?
Osmotic laxative, 12+
What are osmotic laxatives used for? How long to work? How does it work? Side effects?
Ideal for hard stools
- Increases water in colon.
- Works in 2-3 days but 48 hours for lactulose
- Side effect: discomfort, flatulence + cramps at start of lactulose treatment
What are osmotic laxatives used for? How long to work? How does it work? Side effects?
Ideal for hard stools
- Increases water in colon.
- Works in 2-3 days but 48 hours for lactulose
- Side effect: discomfort, flatulence + cramps at start of lactulose treatment
- Macrogol 12+/ 2-11 Movicol-Chronic constipation
- Lactulose 3months +
- Magnesium sulphate 12+
What is senna? What age for senna? What age for senokot + side effect?
Stimulant laxatives
- Senna 6+
- Senokot 12+ (colours urine brown)
What is bisacodyl (Duclolax)? What age?
Stimulant laxative 10+ (Duclolax)
What is Sodium Picosulfate? (Duclolax Picoliqiuid) What age?
Stimulant laxative 10+
What is docusate sodium (DucloEase) What age?
Stimulant laxative + stool softener
18+
How do stimulant laxatives work? What are they used for? How long it takes to work? How long is the course? Side Effects
Stools that are soft but difficult to pass. Short term use: 1 week
Increases intestinal motility by irritating gut lining. Works in 6-12 hours.
- SIDE EFFECTS: Abdo cramps
- Excessive use: HypOkalaemia, diarrhoea, lazy bowel
Senna 6+/Senokot 12+
Bisacodyl 10+ (Dulcolax)
Sodium Picosulfate 10+ (Dulcolax Picoliquid)
Docusate sodium 18+ (DulcoEase) - stool softener too
What are glycerin suppositories? How long it takes to work?
Dose for adults, children under 12 and infants
Counselling
15-30 minutes
4g adults, 2g under 12, 1g infants
COUNSELLING:
- Wash hands with soap
- Remove wrapper
- Lie on side with lower leg straightened out and upper leg bent forward towards your stomach
- Lift upper buttock to expose rectal area
- Insert pointed end first until 1/2 - 1 inch inside. Hold buttocks tgt for few seconds.
- Lie for 5 mins
- Discard used material and wash hands
Counselling for stimulant laxatives?
Take at night to go in the morning. Senna colours urine yellow-brown
Liquid paraffin + age + side effect
Liquid Paraffin 3+ (Not recommended!) Stool softener
Harsh side effect: anal seepage, lipoid pneumonia, malabsorption of fat-soluble vitamins ADEK
Which lax for: pregnant
1st line - Bulk forming/Lactulose
Avoid stimulant laxative - not licensed for preggers
Which lax for: Elderly
Take caution with bulk-forming (risk of gut obstruction, difficult to increase fluid intake)
Which lax for: Children
1st line : Lifestyle
Next 1st line: Lactulose
Which lax for: opioid induced?
Lactulose + stimulant
Avoid bulk forming
Advice for constipation?
2 weeks
- 5 fruit + veg
- 18-30g of fibre a day
- 2.5L of fluids
- 30mins/5 days exercise
- 2-3 alc + alc free days, max 14 units/week
- Toilet: Squat, don’t hurry, morning or 30 mins after meal, don’t hold in
