Constipation

Question 1

CONSTIPATION

Answer 1

Infrequent, difficult stool, most common in women,elderly and pregnancy

Question 2

Red flags:

Answer 2

• Blood in stool
  
  • Anaemia
  • Abdominal pain
  • Weight loss
  • New onset of constipation over 50 years

Question 3

Non drug:

Answer 3

Increase dietary fibre
Adequate fluid intake
Exercise is advised

Review medication as it may be causing it

Question 4

Bulk forming - how often should they be taken?? - what does it do must todo what to prevent intestinal block??

Answer 4

Bulk forming - methyl cellulose ispaghula husk, sterculia )
- Small hard stools - increases faecal mass, stimulates peristalsis
- Takes 2-3 days to work
- Must be taken with enough water to prevent intestinal bloackage

Question 5

Stimulant laxatives- how often does it take for them to work?? Avoid in what?? Co danthramer and co danthrusate are used in what and can make ruin what colour?

Answer 5

Stimulant laxatives (bisodyl,sodium picosulfate,senna,Socrates,glycerol)
- Stimulates colonic nerves - peristalsis
- Takes 6-12 hours to work
- Avoid in intestinal obstruction
- Co-danthramer and co danthrusate used in terminal illness due to carcinogenicity ( red urine)

Question 6

Facecal softeners: examples of them?? What do they do?? What is the quickest acting and what is the time frame?? liquid paraffin avoided why??

Answer 6

liquid parrafin, docusate, glycerol
- Increases water penetration into the still
- Quickest acting (docusate enema take 5-20 mins)
- Liquid paraffin avoided due to anal seepage,granulomatous disease of the GI tract,lipoid pneumonia on aspiration

Question 7

Osmotic laxative- how many dyssss

Answer 7

Osmotic laxative (lactulose, macrogol)
Increases the amount of fluid in the large bowel - peristalsis
Takes 2-3 days to work
Also have faecal softening properties

Question 8

Drug treatment:
Short duration:

Answer 8

• Bulk forming + good hydration = osmotic

Question 9

Chronic:
What can we add if stool remains hard??? If still no change in 6 months?? What can we women only?? - prucalopride - and withdraw what slowly when pt improves

Answer 9

• Bulk forming and good hydration
  
  • If stool remains hard - add or change to macrogol (or lactulose 2nd line)
  • If still no change after 6 months - prucalopride (women only)
  • Withdraw lactulose slowly when pt improves

Question 10

Faecal imp action:
What can we use??? Hard,soft stool (what used if still there)

Answer 10

Hard: macrogol and stimulant once softened
Soft stools - stimulant
Rectal and or glycerol used if still there

Question 11

Opioid induced:
What kind do we use??? If no response what can we use first line and avoid what?

Answer 11

• Osmotic and stimulant
  
  • Naloxegol if no response to first line
  • Avoid bulk forming

Question 12

Pregnancy and BF:

Answer 12

• Dierty and lifestyle = fibre supplements such as bran or wheat
  
  • Bulk-forming = lactulose
  • Bisocodyl or senna if that doesn’t work - don’t use senna near term

Question 13

Children(no faecal impaction vs hard toll)

Answer 13

First line - dietary advice- macrogol (if no faecal impaction= stimulant)
If stool is hard = lactulose or docutatse