Constipation (4.5) Flashcards
What are some properties of constipation?
- Very common
- Often self-diagnosed by patient
- Normal bowel habits –> 3 motions per day to 3 per week
Only an issue if there
>Change from ones normal: reduced frequency, hard stools and/more difficult defecation
For constipation;
A) who is the patient
B) What are the symptoms
C) How long
D) Action taken
E) Medications?
F) Medical conditions
G) Allergies (N/A)
H) Extended questions
A)
- Age: elderly and children
- Gender
- Pregnant or breastfeeding
B)
- Details of current bowel habit –> usual bowel habit
- Pain
- Blood
- Diet and lifestyle
C)
- Persisting change (> 2 weeks-adults and 1 week-child)
- Sudden onset
D)
- Laxative use
E)
- Constipating medications
F)
- Depression, hypothyroidism, parkinsons disease
G)
N/A
H)
- Change of diet our routine?
- Pain on defecation?
- Presence of blood
- Duration (chronic or recent)
- Lifestyle changes?
What are some medications which cause constipation?
See attached image
> Antacids
> Supplements
>Antichlolinergics
>Antihypertensives
>Opioids
When to refer for constipation?
- Blood/mucuous in stool
- >14 days duration with no identifiable cause (for child >7days)
- Pain on defecation
- > 40 years of age (with sudden change in bowel habits)
- Sudden change in bowel habits without obvious cause
- Suspected depression or hypothryoidism
- Vomiting
- Unintentional weight loss
- Tenesmus (continuous feeling of needing to defacate)
- Family history of inflammatory bowel disease (IBD) or colon cancer
What are some non-pharmacological managements for constipation?
- Diet - 2 fruits and 5 vegetables daily
- Exercise
- Fluid intake 2L/day
- Behavioral modification
> FIrst step: assess diet and lifestyle
> Ensure adequate intake of fluid (2L/day)
>Ensure adequate intake of dietary fibre (with sufficient fluid)
- 25g to 30g of fibre daily in adults
- Fibre intake should be increased slowly to avoid flatulence and bloating
> Increase exercise and remain active
> Toileting after meals as maximal gastrocolic reflex
- Maintain good toilet position
- Toilet stool (35-degree angle), use a stool
For constipation, what is the management options based on?
- Symptoms
- Required onset of action
- Patient preference
- Adverse effects
- Effectiveness of previous treatments
- Cost
- Patient characteristics: BF: all safe
> Pregnancy: avoid stimulant laxatives
> Pregnancy: docusate, lactulose and sorbitol are safe
