Constipation Flashcards
what is constipation
infrequent difficult stools
who is more likely to experience constipation
- women
- elderly
- pregnancy
constipation red flags
- blood in stools
- anaemia
- abdominal pain
- weight loss
- new onset in over 50yr+
constipation non-drug tx
- increase dietary fibre
- adequate fluid intake
- exercise
- review medications
what are the different type of laxatives?
- bulk-forming
- stimulant
- faecal softners
- osmotic
examples of bulk-forming laxatives
- methylcellulose
- ispagula husk
- sterculia
how long does it take to work
how does bulk-forming laxatives work
- 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
non-drug
what needs to be taken with bulk-forming laxatives and why
taken with enough water to prevent intestinal blockage
examples of stimulant laxatives
- bisacodyl
- sodium picosulfate
- senna
- docusate
- glycerol
MoA + how long it takes to act
how does stimulant laxatives work
- stimulating colonical nerves = peristalsis
- takes 6-12HR to work
peristalsis = muscle contractions that move food through digestive tract
when should you avoid stimulant laxatives
in intestinal obstruction
when is co-danthramer and co-danthrustate used ?
in terminal illness due to carcinogenicity (red urine)
examples of faecal softners
- liquid paraffin
- docusate
- glycerol
MoA + how long it takes to act
how does faecal softners work
- increases water retention to stools
- quickest acting
- docusate enema = 5-20mins
why is should liquid paraffin avoided
avoid due to anal seepage, granulomatous disease of GIT, lipid pnuemonia on aspiration
examples of osomtic laxatives
- lactulose
- macrogol
MoA + how long it takes to act
how does osmotic laxatives work
- increases fluid to large bowel = persistalsis
- 2-3DY to work
- also has faecal softening properties
what is used for short duration of constipation
- bulk forming + good hydration
- osmotic if needed
what is used for chronic constipation
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
hard stools + soft stools tx
feceal impaction tx
large lump of dry, hard stool = stuck in rectum
1) hard stools = macrogol + stimulant once softened
2) soft stools = stimulant
3) rectal bisacodyl and/or glycerol if still there
tx of opioid-induced constipatiom
AVOID bulk forming
1) osmotic AND stimulant
2) naloxegol if no response
tx of constipation in pregnancy and breast-feeding
1) dietary and lifestyle = fibre supplements e.g. bran, wheat
2) bulk forming then lactulose
3) bisacodyl or senna but AVOID senna near term
tx of constipation in children
1) dietary advice and macrogol if no faecal impaction then stimulant
2) if stool still hard = lactulose or docusate
