Constipation Flashcards
Constipation symptoms
Difficulty passing stools
Passing stools less frequently than usual
Abdominal discomfort
Hard dry stools
Causes of constipation
Lack of exercise
Lack of fibre
Drugs
Lack of fluids
What drugs can cause constipation
Codeine
Antacids (aluminium)
Antispasmodics
Antidepressants
Diuretics
Iron supplements
Anti epileptic meds
Red flags of constipation
Adult >2 weeks
Children > 1 week
Black, red or tarry tools (gastric ulcer)
Clay like stools (Hepatotoxicity)
Continuous tiredness (anaemia)
Laxative abuse
Unexpected weight/ appetite loss
Drug induced constipation
Failed treatment
Pregnant women unless advised by GP to buy otc
A patient presents to you with constipation; he says his stools look tarry and black, what do you suspect and how to respond?
Refer to GP
suspect gastric ulcer
A patient with constipation feels continuous tiredness and fatigue, what could this be?
Anaemia
Refer to GP
A patient with constipation has unexpected weight and appetite loss, suspect ___
Carcinoma
Refer to GP
A patient with constipation has weight gain, coarse hair, lethargy, dry skin
Suspect____
Hypothyroidism
Refer to GP
A patient with constipation suffers from clay like stools, suspect____
What medication could be causing this
Hepatotoxicity
Amiodarone
1st line constipation treatment
Lifestyle- increased fibre, exercise at least 5 days a week 30-60mins, increased fluids and fruit
If lifestyle changes isn’t effective in constipation, offer
Give examples of this class
Bulk laxatives
- sterculia
- methyl cellulose
- isphagula
SE of bulk laxatives
If not taken with water can cause oesophageal obstruction/ intestinal obstruction
Which is the safest laxative in pregnancy
Bull laxatives
- methyl cellulose
- sterculia
- isphagula
If bulk laxatives are in effective in constipation offer:
Give examples
Osmotic laxatives
- lactulose
- macrogol
Onset of bulk laxatives
24hrs but full effect in 2-4 days
Onset of methycellulose
24hrs but full effect in 2-3 days
onset of osmotic laxatives
2-3 days
Lactulose onset
2-3 days
Macrogol onset
2-3 days
Osmotic laxatives SE
Flatulence
Cramps
Abdominal discomfort
Stimulant laxatives examples
Senna
Bisacodyl
Sodium picosulfate
Glycerol suppository
Treatment if constipation
- Lifestyle
- Bulk forming laxatives
- Osmotic
- Stimulant
Onset of stimulant laxatives
6-12 hours
Suppositories onset
Immediately
Senna can colour urine……
Red/ brown
Which laxative colours the urine red/brown
Senna
Can we use stimulant laxatives in pregnancy
No
When can you refuse to sell laxatives OTC
When you suspect laxative abuse
Which is better for constipation, soluble or insoluble fibre and why
Insoluble
Adds bulk to faeces and so passes through gut quicker
Recommended fibre intake daily
30g
Diarrhoea symptoms
Increased frequency of bowel movements
Soft watery stools
Abdominal cramps, flatulence, nausea
Urgent need
Causes of diarrhoea
Laxative overuse
Bacterial/vira infection
