Constipation Flashcards
What is the physiology of the gut?
- Interplay of intestinal smooth muscle
How does the parasympathetic nervous system effect the gut?
Stimulate motility
How does the sympathetic nervous system effect the gut?
Inhibits motility
What other factors are at play in the gut?
GI Hormones
Serotonin
CNS
What is the gastric-coli reflex? Who takes advantage of it?
a physiological reflex that controls the motility of the lower gastrointestinal tract following a meal (increased motility)
- 30 mins after a meal
- Nurses try to take advantage to reintroduce the natural stimulus
What is the normal BM activity?
wide range: 2x per wk to 3x per day
What influences BM activity?
habits and cultural factors
normal flora in colon
Describe the process of fluid recovery in the gut?
1) 9 L of fluid enters duodenum/day
(2 L from diet, 7 L from intetsinal secretions)
2) Approx 8 L absorbed by small intestine
3) Large intestine absorbs 850 mL
4) About 150 mL excreted in stool/day
What happens to a stool as it sits in the intestine?
- Water is absorbed from the stool by the intestine
What can cause constipation?
- Not a normal part of aging
- Disease states
- Drug causes
- Immobility
- Fluids
In regards to constipation, it’s important for pharmacists to know….
What is regular for a patient
What are some causes of constipation?
Dehydration (other sx)
Pain meds
Dehydration
Depression
Stroke
Colon Cancer
Is constipation usually painful?
Potentially however if pain consistently enters the equation, start thinking of another cause (e.g. irritable bowel syndrome)
What are some causes of constipation that a pharmacist should know about?
- Medication Induced –> Anticholinergics, opiods
- Diabetes
- Colon Cancer
- Irritable Bowel Syndrome
- Depression
How long of constipation until we should get worried?
3 days w/t a bowel movement
What are some red flags of constipation?
- Changes in stool texture
- Blood in stool
- Hemorrhoids
- Weight loss
- Decreased appetite
- Nausea
- Vomitting
- Frequent Pain
- Narrower stools
- Unresponsive to tx
When to refer for constipation?
- Blood in stool
- Weight loss
- Decreased appetite
- Nausea
- Vomitting
- Frequent Pain
- Narrower stools
- Unresponsive to tx
- Change in bowel habit of more than 2 weeks
What is a large bowel obstruction? Most common cause?
- Part or all of the large intestine is blocked
- A growth or tumor that blocks the intestine (such as cancer) is the most common cause
What are the symptoms of a large bowel obstruction?
- Belly cramping and pain
- Belly swelling and bloating
- Unable to pass gas
- Unable to pass stool
-Vomiting
More than that normally seen with simple constipation or IBS-C
Is a bowel obstruction chronic?
- Dramatic progression of symptoms
Is excess hydration and fluid intake useful for constipation?
No
Is excess hydration and fluid intake useful for constipation?
No - Normal hydration is fine. Excess water is filtered by the kidney. Does not make it into the intestines.
- If they are dehydrated, need to get them to normal hydration
Can food impact what occurs in your gut?
Yes
- High cheese, high protein diets, certain foods
- Less mass to the intestine, go less
For the vast majority of people, ______ is a good idea
Adding on more fibre
Is soluble or insoluble fibre more useful?
- Insoluble is given credit for better effect
- Either way, when adding it - go slow
When adding on fibre, one should increase by _____ and expect some ____
Increase by up to 5 g per day
Expect some increase in gas
What sources of fibre are the best?
Natural and organic better
What is bowel re-training?
It took years to get where they are
More applicable to the nursing home world
Re-establish the reflex ie defecation stimulation post-meal
Finding ‘best’ time for BM
Are prunes beneficial for constipation?
YES
- Prunes contain sorbitol which has natural, laxative effect in the body (draws out fluid)
- Also high in anti-oxidants and have both soluble an dinsoluble fibre
How many prunes to start out with? How much juice?
Start with approx. 4 prunes
Start with 1/2 cup of juice
