Constipation Flashcards
What are causes of constipation?
Drugs
Bowel pathology: Stricture Diverticular disease Rectal prolapse Anal fissure
Metabolic
Other Dementia Immobility Dehydration Lack of fibre Neurogenic Spinal cord pathology
What drugs cause constipation?
Opiates Iron supplements CCBs - amlodipine, verapamil Antidepressants - tricyclics Antipsychotics Anticholinergics
What metabolic conditions cause constipation?
Hypercalcaemia - bones, stones, moans, groans, thrones
Hypothyroidism
What are non drug treatments for constipation?
Rehydration
Mobilisation
High fibre diet
Medication review
What are the categories of laxatives
Stimulant laxatives
Osmotic (softening) laxatives
Bulking laxatives
Enema
Indication for stimulant laxatives?
Examples?
Use in older patient with normal stool but reduced bowel motility
Senna
Bisacodyl
Sodium picosulphate
Docusate sodium
What are side effects of stimulant laxatives?
Increased motility can cause abdominal cramps
Hypokalaemia
Indication for osmotic, softening laxatives?
Examples?
Treatment of hard stools and relief of painful defaecation
Lactulose
Macrogols (Movicol - polyethylene glycol)
Side effects of osmotic softening laxatives
Dehydration - give adequate fluid intake
Indication for bulking laxatives?
Examples
Inadequate fibre intake
Small hard stools
Fybogel
Isphaghyla husk
Side effects of bulking laxatives
Abdominal distension
Intestinal obstruction
Indications of enema?
Examples?
ADRs
Resistant rectal constipation requiring urgent relief
Phosphate
Sodium citrate
Glycerol suppositories
Pain
Discomfort
What are types of constipation?
Harder stool
Infrequent bowel movements
Difficulty or pain passing stools
What symptoms can contipation present with?
Reduced mobility Falls Confusion Delirium Urinary retention
Reduced appetite Vomiting Abdominal pain Abdominal distension Overflow diarrhoea Faecla incontinence
What Ix in constipation?
FBC
U&E - dehydration, metabolic
Calcium
TFT
AXR - rule out bowel obstruction
Colonoscopy
