Constipation Flashcards
How are faeces formed within the large intestine?
Food passes from the small intestine and passes along the caecum colon and into the rectum by peristalsis
What is reabsorbed in the large intestine?
Water and salts reabsorbed which results in excess drying which can cause constipation.
What bacteria is absorbed in the large intestine?
-Ferment non-digestible polysaccharides, some metabolites are absorbed
-Produce Vitamin K and Biotin (Vit B7), which can be absorbed
-Produce gases from undigested polysaccharides
-Essential for development of caecum and lymphatics system
What is the definition of constipation?
The passage of hard stools, less frequently than the patient’s own normal pattern.
Is constipation a symptom or a disease?
SYMPTOM
What features class as difficulty in opening bowels?
-Going less than 3 times a week
-Straining to open bowels more than 25% of occasions
-Hard or pellet-like stool on more than 25% occasions
What is classed as chronic constipation?
More than 12 weeks in the past 6 months. If it occurs 50% of the time this is chronic constipation.
What is the cause of Constipation?
*Age, the very young or very old
*Diet - Low fibre, High animal fat, Inadequate fluid intake, caffeine and alcohol = diuretics causes harder poo
*Poor bowel habits
*Ignoring the urge to defacate
*Imaginary constipation - not eating as much
*IBS
*Intestinal Obstruction
*Pregnancy
*Travel
*Immobility
*Poor thyroid function
What medications cause constipation?
Antacids (Al and Ca salts), Antispasmodics, Antidepressants (Amitriptyline/Doxepin), Iron tablets, Diuretics, Painkillers, Ca channel blockers, ACE inhibitors, Anticholinergic drugs (Hyoscine), Ulcer healing (PPI’s), Antipsychotics (Haloperidol)
Can laxative abuse cause constipation?
YES
What diseases can cause constipation?
*Diabetic autonomic neuropathy
*Spinal cord injury or tumours
*Cerebrovascular accident
*MS
*Parkinsons disease
*Connective tissue disorders
*Hirschsprungs diseases
What is a symptom of constipation in children?
-Infrequent bowel activity, foul smelling wind and stools, excessive flatulence, irregular stool texture, abdo pain distension or discomfort, soiling/overflow.
What is the main cause of constipation in older people?
*decline in GI motility
*Immobility
*Poor diet - low solid and liquid intake
*Wasting of pelvic floor molecules
*Side effects of medicines
=Can get faecal impaction
When constipation is confirmed what are the appropiate steps taken to manage the issue?
-Lifestyle and dietary changes
-Short courses of laxatives
What is an example of ‘Bulking agents’
Ispaghula husk - Fybogel
Methylcellulose
What is an example of a stimulant laxative?
Bisacodyl (oral and rectal)
Senna
Dantron
Sodium pico-sulphate
What is an example of a faecal softeners?
Docusate (Oral and rectal)
Glycerol (Suppository)
Arachis Oil (Enema)
What is an example of Osmotic Laxatives?
Lactulose
Macrogols - Cosmo-col, Movicol, Laxido
Magnesium
Phosphate
Sodium citrate
What is the first line treatment for constipation?
1) Lifestyle advice and to manage the underlying cause.
If a patient is constipated and the first line hasn’t worked, what would then be recommended?
Bulk forming laxative (Ispaghula husk - Fybogel) or Osmotic laxative (Macrogol/Lactulose)
If when constipated, and the first recommended drugs haven’t worked after 1-3 days, what should then be recommended?
Stimulant laxatives - Senna
When does patient need to stop taking laxatives?
Gradually reduce laxatives and stop once the patient has produced a soft, formed stool without straining at least three times per week.
When someone is chronically constipated what may be the final line of treatment?
Prucalopride - this stimulates GI motility
What is the treatment plan if a patient is faecal impacted/loaded with hard stool?
1) High dose oral macrogol (Movicol, Cosmocol, Laxido)
2) Stimulant (Senna)
If response is inadequate or slow, move onto…
3)Glycerol alone or glycerol plus Bisacodyl suppositories
Then…
4)Sodium Phosphate or Arachis oil rentention enema
If a patient is faecally impacted or loaded with soft stool, what should the treatment plan be?
1) Stimulant (Senna/Bisocodyl)
2) Docusate or sodium citrate mini enema
Should patients who have faecal impaction or loading should they be considered for regular laxatives to maintain bowel movements?
YES!
Pt X has Opioid induced constipation, what laxative should be avoided?
Bulk forming laxatives (Ispaghula husk - Fybogel) because the MOA increases faecal mass and Opioids reduce peristalsis.
What is the treatment plan for a patient with Opioid constipation?
1) Osmotic laxatives (Lactulose/Cosmocol/Movicol/Laxido) or docusate and a stimulant laxative (Senna/bisocodyl)
2) Naloxegol
3) Methylnaltrexone
4) Naidemedine