Constipation And Colonoscopy Flashcards
CONSTIPATION - Not passing stools (faeces) as often as you normally do, you have to strain more than usual or you are unable to completely empty your bowels.
Signs and Symptoms:
✓ Change in your usual pattern
✓ Pain and discomfort when passing unusually hard, lumpy, large or small stool
✓ Time between toilet trips increases
✓ Crampy pain in the lower abdomen
✓ Bloated and feel sick
Risk Factors:
▪ Women
▪ young adult (lifestyle)
▪ pregnant (increased progesterone)
▪ sedentary lifestyle / elderly
Causes:
✓ not eating enough fibre, such as fruit, vegetables and cereals (average 18-25 grams of Fiber /day)
✓ a change in your routine or lifestyle, such as a change in your eating habits
✓ immobility or lack of exercise
✓ not drinking enough fluids (recommended 1.5-2 liters /6-8mugs unless contraindicated)
✓ underlying medical condition (underactive thyroid / Irritable Bowel Syndrome / gut disorders / poor mobility like in elderly)
✓ Medications (painkillers/codeine/morphine/ antacids/antidepressants/Iron tablets
✓ Unknown Idiopathic – could be due to underactive bowel (Functional / Primary Constipation)
Medicines:
1)Bulk forming laxative - makes stool denser and softer, you need to increase fluid intake .
Suitable for pregnant; *effective after 2-3 days, e.g. Fybogel (ispaghula husk), methylcellulose
2) Osmotic laxative - increase the amount of fluid in stool. OK for Children.
You need to increase fluid intake; *effective after 2-3 days
e.g. *Lactulose (Duphalac) – take with caution as may increase blood sugar levels in DM
3) Stimulant laxative - stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus. *effective after 6-12 hours
e.g.*Senna – not suitable at 3rd tri pregnant; Stomach cramps; Diarrhea; Red-brown urine
4) Poo-Softener – letting water into the poo and makes poo easier to pass
e.g. Arachis oil, Docusate Sodium
S/E:
✓ Bloating
✓ Farting
✓ Tummy cramps
✓ Dehydration
✓ Darker pee
Contraindications:
▪ Perforated bowel
▪ Allergy
▪ Phenyketonuria
EXTRA CAUTION!!
✓ Check with GP before taking any laxatives if you have any of the following:
✓ IBS, Crohn’s Dse, Ulcerative colitis
✓ Colostomy or ileostomy
✓ History of Liver and kidney disease
✓ *DM
✓ *Difficulty swallowing
✓ *Lactose-intolerant
Test are recommended if you have any of the following:
✓ Regular constipation (change in bowel habit - investigation for 6 weeks)
✓ Sever symptoms without relief on laxative use
✓ Associated with other symptoms (such as passing of blood, weight loss, bouts of diarrhea, night-time symptoms)
✓ Family history of colon cancer
✓ Family history of Inflammatory Bowel Disease (Crohn’s Dse or ulcerative colitis)
✓ Other unexplained symptoms other than constipation
Health Teaching
Diet- HIGH FIBER .Eating more fibre will keep your bowel movements regular because it helps food pass through your digestive system more easily. Foods high (fruits, veg cereals, wholemeal) in fibre also make you feel fuller for longer
**5-7 portions of fruits and veggies/day
**16-25 gms of fiber
** include Sorbitol draws water into the bowel then softens the stools e.g. fruit juices, fruits as apples, plums, pears,prunes, berries and dried fruits
Increase fluids with the increase of Fiber
Never ignore the urge to go to the toilet. Ignoring increase your chances of having constipation. The best time for you to pass stools is first thing in the morning, or about 30 minutes after a meal.
Exercise. Keeping mobile and active will greatly reduce your risk of getting constipation
FYI:
-GP suspects of faecal impaction (when dry, hard stools collect in your rectum), they may carry out a physical examination.Can be treated with a high dose of the osmotic laxative macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative. If not working then Suppository: this type of medicine is inserted into you anus. Bisacodyl and glycerol
ENEMA: this is when a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.
-constipation can be a sign of colon or rectal cancer, irritable bowel syndrome (IBS), etc
-complications of chronic constipation: haemorrhoids, fecal impaction and fecal incontinence (have psychological effect in children)
COLONOSCOPY - allows to examine your large bowel (the colon) using colonscope – long, thin flexible tube connected to a light and camera at the end then images are displayed in a monitor. The colonscope is inserted into the rectum and moved through the entire colon, doctor may collect tissue sample for biopsy or remove polyp
Pre-procedure
✓ Doctor will discuss procedure and secure CONSENT
✓ Withhold Iron supplements one week prior the procedure
✓ Advise the doctor if you are taking any of the following: Aspirin, Plavix, warfarin (blood thinners or any anticoagulants) 7 days before test
✓ Bowel Preparation:NPO after midnight before the procedure, drinking allowed up to 6 hours before procedure
✓ Observations taken prior
During the procedure
✓ Let patient wear a pair of disposable colonscopy trousers
✓ Make sure that the patient has a company esp if IV conscious sedation is done to drive patient home.
✓ May have *IV conscious sedation – combination of sedative and analgesics, you can follow instructions but cannot talk **Oxygen will be administered if needed during the procedure
✓ Patient will be positioned on left side-lying position with legs flexed or bent
✓ PR, RR and BP will be monitored throughout the procedure.
✓ Air will be pumped through the scope to distend the colon and better visualization
**mild crampy is normal due to the air pumped into the bowel, take slow deep breaths instead
**you can pass wind during the procedure to relieve discomfort
May last 15-45 minutes
Post procedure
✓ If IV sedation was done, you will be monitored and given oxygen if needed, you will not be allowed to drive, operate heavy machines and sign any local documents or make any major decisions for the next 24 hrs.
✓ You need to have someone with you to drive you home .
✓ If no sedation, can resume regular routine including diet and go home on their own unless otherwise contraindicated
✓ It may take 2 before everything goes back to normal, otherwise, report to the doctor
✓ If biopsy done or removal of polyp, you may notice rectal bleeding for 1-2 days
S/E
Rectal bleeding
Bowel perforation
Patient will be ask to stay in the hospital for observation if bleeding following polyp removal is expected
