Constipation Flashcards
Constipation is defined as infrequent defecation, < __ / week, along with other symptoms:______, _______, ______ etc
<3 times per week
straining or painful
hard, lumpy stools
incomplete evacuation
bloating and abdominal discomfort
sense of rectal blockage
Primary constipation is classified as the following:
1)
2)
3)
1) Normal Transit (Normal frequency but stool is hard and or difficult to pass)
2) Slow transit (Infrequent BM)
3) Pelvic floor dysfunction (Neurological)
Secondary constipation is due to ______, _______ or conditions
medications, diseases
Some medical conditions that can lead to constipation:
1)
2)
3)
1) CV disease ( stroke )
2) GI (IBS)
3) Neurological (Parkinsons, spinal cord injury)
Diabetes, thyroid disorders, psychiatric (depression, anxiety)
Common risk factors:
1)
2)
3)
1) Female Sex
2) Pregnancy
3) >65
Changes in diet, low socioeconomic status, low fluid or caloric intake, living conditions, sedentary lifestyle, ignoring urge to defecate
Some examples of medication causes:
Anticholinergics, Antihistamines, Antidiarrheal drugs, Iron, Opioids, NSAIDs, antidepressants etc
RED FLAGS
1)
2)
3)
1) CHILDREN <2
2) CONSTIPATED > 2 WEEKS
3) NO BM 7 DAYS
Blood or mucus in stool, systemic symptoms, symptoms of anemia, family hx of colon cancer, constipation and diarrhea (suggestive of IBS), persistent abdominal pain, severe pain during defacation, recent abdominal surgery, weight loss >5%, abdominal or rectal mass, impaction
Examples of non-pharm include:
increase fibre intake (25-38g)
increase fluids (2.2-3L)
encourage regular daily bowel routine
avoid straining
increase physical activity
First line non-prescription agents are:
1) Bulk forming (psyllium)
2) Osmotic (PEG3350)
Psyllium works by _______ stool fluid content
increasing
Psyllium onset is __ - __ days
1-3 days
Psyllium is contraindicated in _________
fecal impaction
Psyllium must be taken with ____ of ____ to prevent fecal impaction
250 ml of water, avoid esophageal obstruction
Main side effect of psyllium =
bloating, space by 2 hr from other meds
Osmotic laxatives work by drawing fluid into _______ and stimulate peristalsis
the lumen
These two non prescription agents are safe for long term use
1)
2)
Psyllium
PEG
The onset of PEG is __ - __ days
2-4
_____ is more effective and causes less side effects than lactulose
PEG3350
These two osmotic are effective in opioid induced constipation:
1)
2)
PEG
Lactulose
The onset of lactulose is __ - __ days
1-2 days
Common side effects of lactulose include:
Flatulence, cramps, diarrhea, bloating, nausea
Main concern with sorbitol 70% solution is:
bowel necrosis
The osmotic laxative with the fastest onset of 15 min to 1 hour is
glycerin suppositories
Main concern with osmotic saline laxatives like magnesium citrate, magnesium hydroxide, magnesium sulphate, sodium phosphate enema is that they can cause ________
electrolyte imbalances
