Constipation Flashcards
What are symptoms of constipation?
passage of hard, dry stools less frequently than the persons normal bowel movements (this can range from 2-3 times a day to 1-2 times a week, depending on the individuals routine).
also
Abdominal discomfort, bloating and nausea
When would you refer a pt with constipation?
- Continuous use of stimulant laxatives can cause the contents of the gut to be expelled such that no bowel movement occurs for 1-2 days
- use of laxatives can be abused by people who believe that they can help to control weight
- Constipation accompanied by weight and appetite loss - carcinoma?
- Tarry, red, black, blood stools indicate underlying condition - haemorrhoids, gastric ulcer, carcinoma
- Constipation with weight gain, lethargy, coarse hair, dry skin - hypothyroidism
- Constipation caused by drugs - opioid, hyoscine, SSRIs, TCAs, iron, chlorphenamine, bendroflumethiazide, propranolol, aluminium-containing antacids, verapamil
- Greater than 7 days for a child
- Greater than 14 days for an adult
- Pain on defecation
What is first line treatment for pts with constipation?
Manage any underlying secondary cause - - stop any meds causing constipation
- increase fruit and fibre intake
- keep hydrated
- perform regular exercise (30-60 minutes of - physical activity five or more days of the week
- toileting routines - dont hold in or rush
What is second line tx for pts with constipation?
- Bulk-forming laxatives (ispaghula, methylcellulose, sterculia)
The laxative effects usually occurs within 24 hours but can take 2-3 days to reach full effect
How do bulk-forming laxatives work? w
swell up in the gut to increase faecal mass so that peristalsis is stimulated
What is third line tx for constipation?
Switch or add an osmotic laxative (macrogols, lactulose)
How do osmotic laxatives work?
maintaining the volume of fluid in the bowel
It may take up to 2-3 days to work OR add a stimulant laxative (senna, bisacodyl, sodium picosulfate, glycerol suppositories)
How do stimulant laxatives work?
directly stimulates peristalsis through increasing release of water and electrolytes by the intestinal mucosa.
How quickly do stimulant laxatives work?
6-12 hours (overnight) or even quicker if applied as a suppository (within an hour)
What is docusate sodium?
What age can it be used?
Can it be used in BF/P?
has both stimulant and stool-softening properties
> 6 months
Yes
What are side effects that can occur from lactulose?
flatulence, cramps, abdominal discomfort in about 20% of patients especially at the start of tx.
What are the side effects of bukl laxatives?
risk of oesophageal and intestinal obstruction if not taken with sufficient water
What are counselling points you would a give a patient that has constipation?
healthy, balanced diet, plenty of whole grains, certain fruits/veggies, gradual increase in dietary fibre - takes a few weeks to benefit
drinking plenty of water
Why do pregnant women get constipated?
raised progesterone levels during pregnant mean that the gut muscles are more relaxed
Oral iron can also cause constipation
What laxatives should pregnant women avoid taking?
stimulant especially in third trimester
What are the side effects of senna?
colour the urine yellow-brown to red colour because it is excreted via the kidney
What age can the following be used? Senna Bisacodyl Glycerol Sodium picosulfate
Can they be used in BF/P?
- Senna: > 6 years
- Bisacodyl: > 4 years
- Glycerol: infant upwards
- Sodium picosulfate > 10 years
Yes but use others first
What age can lactulose be used? what age can macrogol be used for?
Are they safe for P/BF?
infant upwards - lactulose
Yes but bulkforming first line
what age is ispaghula/sterculia/methylcullose husk used?
Can they be used in P/BF?
Ispaghula: >6 years
Sterculia: >6 years
Methylcellulose: > 12 years
Yes they can - first line
