Constipation

Question 1

Definition / symptoms (6)

Answer 1

Passage stools less frequently than normal pattern
Infrequent stools
Hard/pellet like faeces 
Straining
Sensation incomplete emptying
Lower abdo pain or bloating

Question 2

Causes

Primary (5)

Answer 2

Reduced colonic motility
Reduced mobility
Inadequate hydration and/or fibre
Conscious or unconscious retention of faeces
Behavioural or psychological

Question 3

Causes

Secondary (2)

Answer 3

Pharmacological - opiods, antacids, NSAIDs, iron supplement

Underlying disease - Parkinsons, MS, tumour

Question 4

Treatment

Answer 4

Combo diet, lifestyle + drugs

If secondary then manage/treat cause

Question 5

Dietary interventions (7)

Answer 5

First line treatment
Veg 2-3d
Wholegrain
Fruit - 2-3d, high sorbitol (prune,apple)
Pulses - soup, stew, hummus
Fluid - 2L day
Gradually increase fibre to avoid bloating

Question 6

Bran

Answer 6

Raw unprocessed sometimes used as bulk forming laxative
Take with plenty fluid
Better cooked - breakfast cereal, bread, biscuits
Oat bran may be better tolerated
Excess - associated with obstruction

Question 7

Linseed/flaxseed

Answer 7

22.8g fibre/100g
Start 4-12g -> 24g (1tbsp=12g)
Consume with fluid (150ml per tbsp)
Add to foods - yoghurt, cereal, porridge, bread, salad, soup
Doesn’t matter if golden/brown/whole/ground

Question 8

Pharmacology

Answer 8

1. Bulking agents - soften consistency
2. Osmotic laxatives - encourage movement fluid -> bowel
3. Stimulant laxatives - increase intestinal motility, faecal softeners

NICE 2017 - 1, 2 then 3

Question 9

Exercise

Answer 9

Increased activity + exercise levels

Question 10

Toilet routine (5)

Answer 10

Don’t rush
Position - knees bent higher than hips
Ensure appropriate help to access toilet if less mobile
Supported seating if unsteady
Respond immediately to need of defecation (don’t hold)