Constipation Flashcards
Define constipation
Unsatisfactory defaecation due to infrequent stools, difficult stool passage or seeming incomplete defaecation.
Typically passing less than three stools a week
Most common in women, elderly and pregnancy.
What type of constipation should be further investigated?
New onset
Esp in 50yrs+ with anaemia, abdo pain, weight loss, overt/occult blood - due to risk of malignancy.
If accompanied with vomiting/absolute/ suspect BO.
What lifestyle advice can help treat constipation?
In dietary fibre - should be done gradually to avoid flatulence and bloating.
Foods high in fibre and sorbitol - such as prunes, peaches or fruit juices.
Increased fluid intake
Regular exercise
Toiler routine changes - ensures goes when feels the need, takes time to ensure defecation is complete
What electrolyte abnormality is common in laxative abuse?
Hypokalemia.
What are the different types of laxatives?
Bulk-forming - inc stool weight and soften it (fibrogel)
Stimulant - stimulate nerves in colon
Faecal softeners - inc water and fat in stool
Osmotic laxatives - draw water into colon
What are the different stool types on a Bristol Stool Chart?
Give an overview of bulk-forming laxatives
Examples – fybogel
Mechanism – indigestable hydrophilic colloids – absorb water and swell – increasing faecal mass and GI wall distention – stimulate peristalsis
Usually takes 2-3days to work, often used in IBS, Diverticulitis and safe in elderly
Side effects = bloating and flatulence, interfere with warfarin absorption,
Cautions = needs to be taken with fluids or can cause a blockage – avoid in fluid restricted patients. Use with care if risk of obstruction such as strictures or many adhesions
Give an overview of osmotic laxatives
Example – lactulose, milk of magneisum, glycerin, macrogol
Mechanism – poorly absorbable and hydrophilic -> keep water in the lumen, fecal matter not as hard, easier to pass. Can work in as fast as 1hr
Side effects – high risk of dehydration and electrolyte imbalances in patients with renal failure (cautious in elderly). Cramping and bloating.
Give an overview of stool softners
docusate
Mechanims – allows water and lipid to penetrate stools -> softer and easier to pass.
Usually take longer than other laxatives, used in patients who should not strain such as post surgical, post natal, hemorrhoids, HTN or hernias.
Give an overview of stimulant laxatives
example = senna
Cause direct stimulation of ENS and colonic secretions. Takes 8-24hrs to work
Side effects – accumulation of melanin causes urine and bowel discoloration.
What are some symptoms of constipation?
Fewer than three bowel movements a week
Difficult time passing stools
Lumpy or hard stools
A feeling of being blocker or of not having fully emptied your bowels.
Elderly may also present with constipation
What are some medical conditions that can cause constipation?
Neurological - stroke, Parkinsons disease, spinal cord injury
Diabetes
Tumours or blockages
Pelvic floor disorders, Irritable bowel syndrome.
Alzheimers disease - not causative but can increase the risk
Medications - Parksinsons disease drugs, iron supplements, anaesthesia, opiods
At what point is constipation considered chronic?
3 months or more
What is important to ask about the patients bowel motions if they are constipated?
How often? normal?
Consitency?
Colour?
Bloor or mucous?
Pain or straining?
Feeling incomplete emptying of stools?
Duration
What associated symptoms need to be considered in a patient with constipation?
Abdo pain
Abdo distention or bloating
Nausea or vomiting - faeculent or bilious
Loss of appetite
Overflow diarrhoea
Urinary retention
Any confusion or derlirium
