Constipation Flashcards
risk factors for constipation
female non white over 65 fewer years of formal education low caloric intake increased number of meds lower socioeconomic status sedentary lifestyle travelling toilet training in children ignoring the urge to defecate physical and sexual abuse
diseases causing constipation
IBS IBD stroke, MS, parkinsoons diabetes chronic renal failure carcinoma psychiatric anal fissures
meds that cause constipation
antacids anticholinergics iron supplements analgesics antihypertensive agents
lifestyle causes of constipation
inadequate fibre inadequate fluids lack of exercise travel pregnant ignore urge to defecate
signs and symptoms of constipation
infrequent defecation abdominal discomfort nausea vomiting anorexia early satiety small hard stools incomplete rectal emptying rectal bleeding due to hemorrhoids weight loss
red flags
symptoms last longer than 2 weeksor no bowel movement in 7 days with laxative use blood in stool - dark tarry mucus rectal bleeding severe pain fever unexplained weight loss family history of colon cancer under 2 unremitting nocturnal symptoms recent ab surgery anemia vomiting chronic illness associated eating disorder diarrhea alternating with constipation rectal or ab mass
goals of therapy
relieve contipation and symptoms improve stool consistency reestablush normal bowel function prevent recurrence avoid complication
preventing constipation
high fibre- popcorn, green pea, avocado adequate fluid routine private toilet regimen defecate when feel the urge daily physical activity
non pharms
increase calories eat more fruit exercise footstool puts pelvis lower than knees biofeedback try defecate 5-15 min after meal juice with sorbitol
agents that cause softening of feces in 12-72 hours
bulk forming
emollient
agents that work in 6-12 hours
bisacodyl
senna
agents that work in 0.5-3 hours
magnesium products
oral sodium phosphates
lactulose onset
24-48 hours
glycerin suppository onset
15-30min
peg onset
2-4 days
enema onset
5-15 min
mineral oil, lansoyl onset
6-8 hours
use of product for treatment?
prevention?
1 week treatment
duration ongoing for prevention
treatment for under 1 year
increase fluid
pediatric glycerin suppositories
children over 1 first line agents
PEG, lactulose, sorbital
ogents for only over 6 years old
bulk formin
mineral oil
lansoyl
senna tablets
agent for only above 12
bisacodyl
agents for only over 18
PEG
cause of constipation in pregnancy
elevations in progesterone causign relaxtion in intestinal tract reduced motilin levels intestinal pressure decreased exercise ability iron and calcium supplements
first line treatment in pregnancy
bulk forming laxative
glycerin supp
treatment in elderly
bulk forming agents - must increase fluid but cant if have CHF, renal failure
glycerin supp
PEG
senna, bisacodyl
treatment in cancer patients
stimulatn laxatives
avoid bulk formin becuase may cause impaction
when should laxatives be taken in relation to other drugs
2 hours after
whats a habitual laxative abuser
believes should have a bowel movement everyday
signs and symptoms of laxative abuse
diarrhea - severe chronic watery at night ab pain, NV weight loss muscle weakness hypokalemia, hypocalemia
treatment of laxative abuse
referral
weaning off
add high fibre and bulk forming
encourage exercise and fluid intake
examples of bulk forming agents
psyllium
polycarbophil
inulin
bran
MOA bulk forming
dissolve in intestinal fluid by attracting water forming a gel and stimulatin peristalsis
increases stool frequency and weight
CI bulk forming
partial mechanical obstruction fluid restricted patients partial bowel obstruction fecal impaction dysphagia Gi strictures throat problems
side effects of bulk forming
flatulence
bloating
examples of stool softeners/emollients
docusate sodium
docusate calcium
side effects of stool softeners
mild transient nausea
gi cramps
rash
stool softener MOA
surfactant that helps water in the bowel mix with fecal mass
use of stool softeners
prevention only and even that is lacking evidence
lubricant MOA
lubricates feces and mucosa
reduce water reabsorption
example of lubricant
mineral oil
laxative jelly
CI lubricants
bedridden appendicitis rectal bleeding dysphagia gastric retention gerd MS PD children, elderly high risk of aspiration
stimulant MOA
increase peristalsis
stimulant examples
senna - anthraquinones
cascara sagrada
bisacodyl - diphenylmethane
what should you avoid with bisacodyl
milk antacids PPIs crushing, breaking, chewing because enteric coatin
first line for opiate constipation
stimulants
side effects of stimulants
ab pain
NV
hypokalemia,dehydration, hyponatremia - long term
MOA osmotics
ions draw water into intestine increasing the intraluminal pressure applying a mechanical stimulus for motility
examples of osmotics
glycerin supp lactulose sorbitol PEG magnesium hydroxide/citrate sodium phosphate
can lactulose be used in diabetes
yes
safest and most effective product
glycerin suppository
what is used for bowel cleansing
magnesium citrate
why should you never use oral sodium phosphate as a purgative
serious electrolyte, kidney, cardiovascular, and neurological problems
options for enemas
mineral oil
phosphate
tap water
