Constipation And Bowel Cleansing Flashcards
What are the symptoms of constipation?
Infrequent stools
Difficulty passing stools
Sensation of incomplete emptying
Excessive straining
Lower abdominal pain or discomfort
Bloating
What are the red flags of constipation?
New onset constipation in over 50 years Anaemia Abdominal pain Unexplained weight loss Overt or occult blood
What are the bulk forming laxatives?
Sterculia
Ispaghula husk
Methylcellulose
What are the osmotic laxatives?
Magnesium hydroxide
Lactulose
Macrogol
What are the softener laxatives?
Liquid paraffin / docusate
What are the stimulant laxatives?
Co-danthramer Glycerol suppositories Bisacodyl Sodium picosulfate Co-danthrusate Senna Docusate
What are the chloride channel agonists?
Lubiprostone
What are the selective 5HT4 agonists?
Prucalopride
What is the first line laxative?
Bulk forming
Ideal for small, hard, stools and fibre deficient diets
How do bulk forming laxatives work?
Swells in gut to increase faecal mass to stimulate peristalsis
Works within 24 hours but takes 2-3 days for full effect
What are the side effects of bulk forming laxatives?
Bloating
Cramping
Flatulence
Gut obstruction
What are the counselling points for bulk forming laxatives?
Maintain adequate fluid intake to avoid gut obstruction
Swallow with plenty of water and not immediately before bed
What is the risk of ispaghula husk?
Contains potent allergens so risk of hypersensitivity
Are osmotic laxatives first or second line?
Second line
If stools remain hard, add or switch to osmotic laxative
How do osmotic laxatives work?
Increase water in colon
Lactulose causes osmotic diarrhoea of low faecal pH
Macrogols sequester fluid in bowel
Works within 2-3 days, 48 hours for lactulose
What are the side effects of osmotic laxatives?
Discomfort, flatulence, cramps, nausea when starting lactulose
Nausea - reduced by administering with water, fruit juice or meals
When are stimulant laxatives used?
Third line
Add if stools are soft but difficult to pass/incomplete emptying
Short term use
How do stimulant laxatives work?
Increases intestinal motility by irritating gut lining
Glycerol suppositories work in 15-30 mins
Works within 6-12 hours
What are the side effects of stimulant laxatives?
Abdominal cramps
Senna colours urine yellow-brown
Hypokalaemia, diarrhoea, lazy bowed
What are the counselling points for stimulant laxatives?
Take at night to pass stool in morning
Moisten suppositories with water before use
What are the side effects of dantron?
Genotoxic
Carcinogenic
Red urine
Local irritation/excoriation
What are the side effects of faecal softeners?
Anal seepage
Lipoid pneumonia
Granulomatous disease of GI tract
Malabsorption of ADEK
What are lubiprostone and prucalopride used for?
If at least two laxatives have been the highest tolerated recommended doses for at least 6 months
Prucalopride in women only
What do you use for opioid induced constipation?
OS
Osmotic or docusate sodium + stimulant
Co-danthramer in palliative care
Methylnaltrexone/naloxegol
Avoid bulk forming laxatives
What is used for chronic constipation?
BOS - bulk, osmotic, stimulant
Macrogol is choice osmotic laxative
What is used for constipation in children?
Children love M&S
Macrogol + diet
+ stimulant
+ lactulose or softener if stools remain hard
What is used for constipation in pregnancy?
Pregnant women are DBOS
Diet Bulk forming Osmotic Stimulant - bisacodyl or senna Docusate or glycerol suppositories
Avoid senna if near term/history of unstable pregnancies as can stimulate uterine contractions
What is used for constipation in breast feeding?
BOS
Bulk forming
Lactulose or macrogol
Stimulant
