Constipation

Question 1

Constipation symptoms

Answer 1

Difficulty passing stools
Passing stools less frequently than usual
Abdominal discomfort
Hard dry stools

Question 2

Causes of constipation

Answer 2

Lack of exercise
Lack of fibre
Drugs
Lack of fluids

Question 3

What drugs can cause constipation

Answer 3

Codeine
Antacids (aluminium)
Antispasmodics
Antidepressants
Diuretics
Iron supplements
Anti epileptic meds

Question 4

Red flags of constipation

Answer 4

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

Question 5

A patient presents to you with constipation; he says his stools look tarry and black, what do you suspect and how to respond?

Answer 5

Refer to GP
suspect gastric ulcer

Question 6

A patient with constipation feels continuous tiredness and fatigue, what could this be?

Answer 6

Anaemia
Refer to GP

Question 7

A patient with constipation has unexpected weight and appetite loss, suspect ___

Answer 7

Carcinoma
Refer to GP

Question 8

A patient with constipation has weight gain, coarse hair, lethargy, dry skin

Suspect____

Answer 8

Hypothyroidism
Refer to GP

Question 9

A patient with constipation suffers from clay like stools, suspect____

What medication could be causing this

Answer 9

Hepatotoxicity

Amiodarone

Question 10

1st line constipation treatment

Answer 10

Lifestyle- increased fibre, exercise at least 5 days a week 30-60mins, increased fluids and fruit

Question 11

If lifestyle changes isn’t effective in constipation, offer
Give examples of this class

Answer 11

Bulk laxatives
- sterculia
- methyl cellulose
- isphagula

Question 12

SE of bulk laxatives

Answer 12

If not taken with water can cause oesophageal obstruction/ intestinal obstruction

Question 13

Which is the safest laxative in pregnancy

Answer 13

Bull laxatives
- methyl cellulose
- sterculia
- isphagula

Question 14

If bulk laxatives are in effective in constipation offer:

Give examples

Answer 14

Osmotic laxatives
- lactulose
- macrogol

Question 15

Onset of bulk laxatives

Answer 15

24hrs but full effect in 2-4 days

Question 16

Onset of methycellulose

Answer 16

24hrs but full effect in 2-3 days

Question 17

onset of osmotic laxatives

Answer 17

2-3 days

Question 18

Lactulose onset

Answer 18

2-3 days

Question 19

Macrogol onset

Answer 19

2-3 days

Question 20

Osmotic laxatives SE

Answer 20

Flatulence
Cramps
Abdominal discomfort

Question 21

Stimulant laxatives examples

Answer 21

Senna
Bisacodyl
Sodium picosulfate
Glycerol suppository

Question 22

Treatment if constipation

Answer 22

1. Lifestyle
2. Bulk forming laxatives
3. Osmotic
4. Stimulant

Question 23

Onset of stimulant laxatives

Answer 23

6-12 hours

Question 24

Suppositories onset

Answer 24

Immediately

Question 25

Senna can colour urine……

Answer 25

Red/ brown

Question 26

Which laxative colours the urine red/brown

Answer 26

Senna

Question 27

Can we use stimulant laxatives in pregnancy

Answer 27

No

Question 28

When can you refuse to sell laxatives OTC

Answer 28

When you suspect laxative abuse

Question 29

Which is better for constipation, soluble or insoluble fibre and why

Answer 29

Insoluble Adds bulk to faeces and so passes through gut quicker

Question 30

Recommended fibre intake daily

Answer 30

30g

Question 31

Diarrhoea symptoms

Answer 31

Increased frequency of bowel movements Soft watery stools Abdominal cramps, flatulence, nausea Urgent need

Question 32

Causes of diarrhoea

Answer 32

Laxative overuse Bacterial/vira infection