Constipation Flashcards
Symptoms
Infrequent stools, difficulty passing stools, incomplete emptying
What do nice say on constipation
Less 3 times a week
Extended symptoms
Lower abd pain
Bloating
Excess straining
Lifestyle
No alcohol, increase fibre, exercise, water toilet routine. Feet on stool
ALARM symptoms (new)
New symptoms Age over 50 , blood in stools, anaemia , weight loss ,abdominal pain, fever
1st line constipation
Non pharmacological measures
2nd line + example +MOA +S/e
Bulk (ispaghula, sterculia, methylcellulose)
MOA= increase faecal mass stimulate peristalsis work fully in 2-3 days (72hrs)
S/e bloating, Cramps, flatulence, gut obstruction - avoided by drinking plenty water
Counselling bulk
- adequate amount of water avoid gut oBstructuon
- swallow plenty of wa term and avoid at night
Warning in ispaghula husk
potent allergen = hypersensitivity
Osmotic laxative example, MOA , S/E
Macrogol 3350, llactulose, MGOH
3rd line - can add to bulk to soften stool or just alone
MOA increase water in colon by drawing water from body or from the water it’s drank
Macrogol - sequesters fluid
Lactulose - cause osmotic diarrhoea off low faecal ph
Works in 2-3 days 72hr, 48hrs for lactulose
S/e discomfort, flatulence, nausea When start lactulose so tske with orange juice, water or meals
MOA/ side effect stimulant
Works by increase gut motility by irritating the gut lining
Glycerol works 15-30 mins
Others take 6-12hrs
S/e cramps, colours urine yellow -ubrown, Excessive use = diarrhoea, lazy bowel , hypokalaemiaty
Osmotic lax macrogol PEG and starch thickened foodds
Don’t use as increases risk of aspiration by dysphagia
Stimulant laxative how long can use and why used
Short term use 1 week - 4th line and used to help stools pass that are already soft
Examples of stimulant
Senna , bisacodyl, glycerol , docusste, sodium picosulfate
Counselling point stumulant
Take at night so first pass in morning
Wet glycerol suppository before use
Co-dantramer or co-dantrusate
These are stimulant laxative that are genotoxic and carcinogenic
S/e of co-danthramer and danthrusate
1)carcinogenic used in terminally ill agent
2) colours urine red
3) local irritation and excoriation avoid prolonged skin contact
Other laxatives with faecal softening properties
1) methylcellulose= bulk
2)docusate (weak stimulant)
3)glycerol Rectal stimukant)
Example of faecal softener main and why not reccmoned
Liquid paraffin
S/e anal seepage, lipoid pneumonia, granulamtous of gi
2) causes malabsorption of fat soluble fits ADEK
5HT4 antagonists example and when to use
If 2 diff classes of laxative have been tried at highest tolerated doses for at least 6 months = 5ht receptor antagonists
Prucalopride (women only)
Lubiprostone
