Constipation

Question 1

what is constipation? most common in who?

Answer 1

-infrequent, difficult stoops, most common in women , elderly and pregnant

Question 2

what are some red flags for constiptation?

Answer 2

-blood
-anaemia
-abdominal
-weight loss (UNEXPLAINED)
-new onset constipation over 50 years

BAAWN

Question 3

What is some no-drug treatment?

Answer 3

-increase in dietary fibre
-adequate fluid intake
-exercise is advised

-review medication might be the reason

Question 4

what drug if it cause constipation it is a big red flag?

Answer 4

clozapine

Question 5

what are some examples of bulk-forming laxatives?

Answer 5

methylcellulose, isaphguhla husk and sterculia

Question 6

how do bulk-forming laxatives work?

Answer 6

-small hard stools-increase faecal mass, stimulating peristalsis
-takes 2-3 days to work
-must be taken with enough water to prevent intestinal blockage

Question 7

what are some examples of stimulant laxatives?

Answer 7

-bisacodyl, sodium picosulfate, senna, docusate, glycerol

Question 8

how stimulant laxatives work?

Answer 8

-stimulating colonic nerves induces peristalsis
-take 6-12hrs to work
-avoid in intestinal obstruction
- used in terminal illness due to carinogenicity (red urine)=only used in end of life

Question 9

what are some examples of faecal softeners?

Answer 9

-liquid paraffin, docusate, glycerol

Question 10

how do faecal softness work?

Answer 10

-increases water penetration into the stool
-quickest acting (docusate enema takes 5-20mins)
-liquid paraffin: avoided due to anal seepage, granulomatous disease of the GI tract, lipoid pneumonia on aspiration

Question 11

what are some examples of osmotic laxatives ?

Answer 11

lactulose macrogol

Question 12

how does osmotic laxatives work?

Answer 12

-increase amount of fluid in the large bowel inducing peristalsis
-take 2-3 days to work
-also have faecal softening properties

Question 13

what treatment can be used for short term?

Answer 13

-bulk-forming + good hydration if it doesn’t work try osmotic

Question 14

what drug treatment can used for chronic constipation?

Answer 14

-bulk-forming + hydration
-if stool remains hard add or change to macro gol (or lactulose 2nd line)
-if still not change after 6 months try prucalopride (only in women)
-withdraw lactulose slowly when patient improves

Question 15

what is the treatment for faecal impaction?

Answer 15

-hard stools: macrogol+ stimulant once softened
-soft stools: stimulant
-recatal bisacodyl and /or glycerol used if still there

Question 16

what is the treatment for opioid induced?

Answer 16

osmotic and stimulant
naloxegol if no repose to first line
avoid bulk forming- as parasltaisi is already slow can cause obstruction

Question 17

what is the treatment for contestation of pregnant and breast feeding women?

Answer 17

-dietary ad lifestyle should use fibre supplements such as bran or wheat
-bulk-forming if not use lactulose
-bisacodyl or Senna if that doesn’t work (dont use Senna near term)

Question 18

what treatment for contraption for children?

Answer 18

-first line: dietary + macrogol (if no faecal impaction) then us stimulant
-if stool is hard then use lactulose or docusate