Constipation Flashcards
What is the most common cause of constipation post op?
Paralytic ileus
What are causes of contipation post-op?
Post operative ileus
Physiological - due to low fibre diet or poor fluid intake
Iatrogenic - medications such as opioid analgesia, anticonvulsants, antihistamines
Functional - painful defecation (fissures)
Pathological - bowel obstruction, hypercalcaemia, hypothyroidism
What are risk factors for constipation?
Intra-operative factors - excessive bowel handling Poor diet, fluid intake reduced mobility AGe MEdications
What are the clinical features of constipation?
Reduced stool - type 1 and type 2
Abdominal distention, nausea and vomiting, anorexia, abdominal pain if severe
DRE - assess degree of fecal impaction
Assess for signs of bowel obstruction
What investigations for constipation
Mostly benign
TFTs serum Ca
Abdominal XR may show fecal impaction
What is the management for constipation?
Conservative management:
Adequate hydration, sufficient dietary fibre, early mobilisation
Pharmacological
Laxatives
What are the types of laxatives?
Osmotic laxatives - increase the amount of fluid in the bowel, softening the stool - lactulose
Stimulant laxatives - stimulate th bowel to contract thus expelling faeces - senna
Bulk forming laxatives - help stool retain water, softening it - ispaghula
Rectal medications - glycerin suppository (stimulant), phosphate enema (stimulant)
How should you decide which laxative?
Patients with hard stool and chronic constipation will benefit from stool-softening laxative such as lactulose but may require glycerine suppositories to soften rectal stool initially
Patients with post-op ileus, opioid induced constipation or soft stool will benefit from stimulant laxative like senna
What is prophylaxis for constipaiton?
Avoid opioid analgesia where possible
Prophylactic stimulant laxative like senna in patients on opioid analgesia especially in elderly
