Constipation

Question 1

what is constipation

Answer 1

infrequent difficult stools

Question 2

who is more likely to experience constipation

Answer 2

• women
• elderly
• pregnancy

Question 3

constipation red flags

Answer 3

• blood in stools
• anaemia
• abdominal pain
• weight loss
• new onset in over 50yr+

Question 4

constipation non-drug tx

Answer 4

• increase dietary fibre
• adequate fluid intake
• exercise
• review medications

Question 5

what are the different type of laxatives?

Answer 5

• bulk-forming
• stimulant
• faecal softners
• osmotic

Question 6

examples of bulk-forming laxatives

Answer 6

• methylcellulose
• ispagula husk
• sterculia

Question 7

how long does it take to work

how does bulk-forming laxatives work

Answer 7

• used when stools = small and hard
• increases faecal mass and stimulates peristalsis
• takes 2-3 days to work

peristalsis = muscle contractions that move food through digestive tract

Question 8

non-drug

what needs to be taken with bulk-forming laxatives and why

Answer 8

taken with enough water to prevent intestinal blockage

Question 9

examples of stimulant laxatives

Answer 9

• bisacodyl
• sodium picosulfate
• senna
• docusate
• glycerol

Question 10

MoA + how long it takes to act

how does stimulant laxatives work

Answer 10

• stimulating colonical nerves = peristalsis
• takes 6-12HR to work

peristalsis = muscle contractions that move food through digestive tract

Question 11

when should you avoid stimulant laxatives

Answer 11

in intestinal obstruction

Question 12

when is co-danthramer and co-danthrustate used ?

Answer 12

in terminal illness due to carcinogenicity (red urine)

Question 13

examples of faecal softners

Answer 13

• liquid paraffin
• docusate
• glycerol

Question 14

MoA + how long it takes to act

how does faecal softners work

Answer 14

• increases water retention to stools
• quickest acting
• docusate enema = 5-20mins

Question 15

why is should liquid paraffin avoided

Answer 15

avoid due to anal seepage, granulomatous disease of GIT, lipid pnuemonia on aspiration

Question 16

examples of osomtic laxatives

Answer 16

• lactulose
• macrogol

Question 17

MoA + how long it takes to act

how does osmotic laxatives work

Answer 17

• increases fluid to large bowel = persistalsis
• 2-3DY to work
• also has faecal softening properties

Question 18

what is used for short duration of constipation

Answer 18

• bulk forming + good hydration
• osmotic if needed

Question 19

what is used for chronic constipation

Answer 19

1) Bulk forming and good hydration
2) if still hard stools add or change to macrogol or lactulose
3) WOMEN - still no change after 6MT = procalopride

withdraw lactulose slowly when improvement

Question 20

hard stools + soft stools tx

feceal impaction tx

large lump of dry, hard stool = stuck in rectum

Answer 20

1) hard stools = macrogol + stimulant once softened
2) soft stools = stimulant
3) rectal bisacodyl and/or glycerol if still there

Question 21

tx of opioid-induced constipatiom

Answer 21

AVOID bulk forming
1) osmotic AND stimulant
2) naloxegol if no response

Question 22

tx of constipation in pregnancy and breast-feeding

Answer 22

1) dietary and lifestyle = fibre supplements e.g. bran, wheat
2) bulk forming then lactulose
3) bisacodyl or senna but AVOID senna near term

Question 23

tx of constipation in children

Answer 23

1) dietary advice and macrogol if no faecal impaction then stimulant
2) if stool still hard = lactulose or docusate