Constipation

Question 1

What is constipation (4)

Answer 1

1. bowel movements occur irregularly
2. failure to completely empty the bowel.
3. Bowel movements may be dry and hard or abnormally large or small when passed.
4. Constipation can be suspected if they have not had a bowel movement at least three times during the last week, the stools are hard, dry, or lumpy, they are straining or in pain when passing a stool.

Question 2

What are the causes of constipation (6)

Answer 2

1. Poor diet - insufficient fibre
2. Insufficient fluid intake
3. Pregnancy
4. Elderly people
5. Medicines (e.g. codeine-based)
6. Lifestyle changes

Question 3

When do you refer to the pharmacist (7)

Answer 3

1. Has tried a laxative already, especially if they are taking them long term
2. Has alternating diarrhoea and constipation
3. Is losing weight without trying
4. Is in severe pain
5. Has rectal bleeding
6. Has a changed bowel habit that has lasted longer than a week
7. Cannot identify a possible reason for being constipated

Question 4

What are the different types of laxatives (4)

Answer 4

1. Osmotic laxative - increase water (Lactulose, macrogols)
2. Stimulant laxative (senna, bisacodyl)
3. Doxusate sodium - laxative with stimulant and softening effects
4. Glycerin suppositories - stimulant with lubricant properties

Question 5

How are laxatives misused (3)

Answer 5

1. a customer that comes in frequently to buy a large amounts of laxatives, with the belief that laxatives can aid with weight loss.
2. Prolonged use of laxatives can also stop the bowel from working effectively on its own.
3. If you have anyone you suspect is misusing laxatives you need to speak to your pharmacist and ask them what they want you to do.

Question 6

What are haemmorrhoids (5)

Answer 6

1. also known as piles
2. swollen veins in the back passage (internal haemorrhoids) or around the anus (external haemorrhoids).
3. They can be very painful, itchy and can sometimes bleed.
4. Haemorrhoids and constipation are sometimes linked - someone who is constipated will strain to pass stools, causing the veins to enlarge which can lead to haemorrhoids.
5. Once these are present, passing stools becomes extremely painful which will put sufferers off opening their bowels, which in turn leads to constipation.

Question 7

What questions do you need to ask for haemmorrhoids (2)

Answer 7

1. WWHAM
2. External or internal

Question 8

When should you refer haemmorrhoids to the pharmacist (2)

Answer 8

1. Is experiencing symptoms for the first time
2. Has bleeding from the back passage, or if the blood is not “fresh” but darker and brown in colour

Question 9

How are haemmorrhoids treated (6)

Answer 9

1. Creams and ointments for itchy sore skin
2. Suppositories for internal haemmorrhoids
3. Local anaesthetic (lidocaine) - relieve pain
4. Astringents (Bismuth subgallate, zinc oxide) - Soothing agent
5. Anti-inflammatory (hydrocortisone) - Reduce enlargement and inflammation
6. Antispetics (Balsam of Peru) - Protect anal membranes

Question 10

What is irritable bowel syndrome (4)

Answer 10

1. a chronic, relapsing, and often debilitating lifelong gastrointestinal disorder with no discernible cause. It needs to be diagnosed by a doctor.
2. IBS usually starts in early adulthood and is more common in women than it is in men.
3. The symptoms can vary and often include alternating bouts of diarrhoea and constipation, as well as pain and bloating in the abdomen.
4. People with IBS, particularly those with painful spasms, can use antispasmodics such as mebeverine, alverine, hyoscine butylbromide or peppermint oil alongside dietary and lifestyle modifications.

Question 11

What is the preferred choice of treatment of IBS (4)

Answer 11

1. For people with constipation, laxatives can be recommended.
2. Bulk-forming laxatives are the preferred choice of treatment in IBS.
3. Lactulose is not recommended.
4. For people with diarrhoea, antimotility drugs such as loperamide can be used, provided there has been an initial diagnosis by a doctor.

Question 12

What advice is given for IBS (4)

Answer 12

1. keeping a food diary to record improving or worsening symptoms with certain foods
2. modifying the amount of dietary fibre according to symptoms
3. having regular meals without skipping any or leaving long intervals between meals.
4. Exercise and reducing stress can also help to try and reduce the severity of IBS symptoms.