Constipation and Diarrhoea Flashcards
Constipation Definition
Excessive straining, incomplete evacuation, failed/lengthy attempts of defecate, hard stools, less frequent number of stools per week
Rome IV Criteria of Constipation
Must include 2 or more of the following: - Straining during defecation - Lumpy or hard stools - Sensation of incomplete defecation - Sensation of anorectal obstruction/blockage - Manual maneuvers to facilitate ALL OF THESE FOR MORE THAN 25% - Fewer than 3 spontaneous bowel movements per week
Mechanism of action
- Food enters colon and it is liquid
- Water is removed due to transverse, ascending and descending colons
- Excessive water removal causes hard stools
Aetiology of Constipation
- Lack of fibre
- Low fluid intake
- Sedentary lifestyle
- Pregnancy
- Medications
- Undiagnosed conditions
- Too much dairy
- Too much sugar and unhealthy fats
- Too much supplemental calcium and iron
- Out of balance gut bacteria
- Laxative abuse
More common in females, elderly, children and pregnant women
Complications of constipation
- Anal sphincter muscles can weaker
- Anal fissures (tears caused by straining)
- Haemarrhoids(first degree/second degree/third degree piles
- Faecal and urinary incontinence
- Pelvic floor is weakened due to straining - may cause bloated feeling
Symptoms of constipation
Abdominal discomfort, cramps, bloating, feeling of incomplete defecation, discomfort when passing stool, requiring manual assistance
When to refer
- Unexplained weight loss
- Large amounts of blood in stool
- Constipation with nausea and vomiting
- Impacted
- Laxative abuse suspected
See GP if you have bowel cancer symptoms for more than 4 weeks
Laxative abuse
Used to achieve weight loss
- causes dehydration, electrolyte imbalance and mineral deficiencies
- Long-term/permanent damage to digestive system
- Chronic constipation
- Damage to nerves and muscles of colon
Lifestyle advice for constipation
- Increase fluid intake (1.5-2L/day)
- Increase physical activaty (150mins/week)(20 mins vigorous exercise)
- Increase fibre intake (30g/day)
Fibre sources
- INSOLUBLE
- pectans + beta glucans (fruits and oats)
- Attracts water into stool making it softer and easier to pass
- Promotes a healthier bowel
- Insulin sensitivity (reduces diabetes) - SOLUBLE
- cellulose - wholegrain foods and nuts
- 3g/day
- Dissolves to create a gel and improves digestion
- Reduces cholesterol, improves blood glucose and reduces diabetes
Bulk forming laxatives
ISPAGHULA, FYBROGEL, STERICULIA
- Retains water in gut
- Increases faecal bulk
- Stimulate peristalsis
- Onset of action = 12-24 hours
- Side effects: Bloating, distention (abdominal pressure) and flatulence (passing of gas)
Osmotic Laxatives
LACTULOSE, MACRGOLS, MOVICOL
- Increases water absorption in colon
- Increases faecal bulk
- Stimulates peristalsis
- Onset of action = 4-48 hours
Stimulant Laxatives
SENNA, BISACODYL
- Stimulate colonic nerves
- Increase intestinal motility
- Stimulate peristalsis
- Onset of action = 8-12 hours
- Take at night, defecate in morning
- Risk of fluid and electrolyte imbalance if used frequently
Stool softeners
DOCUSATE SODIUM, GLYCEROL
- Reduce surface tension
- Increase penetration of intestinal fluid into faeces
- Stimulate peristalsis
Prucalopride
- Selective serotonin 5HT4 agonist
- 2mg strength
- When no other treatments have an effect
Constipation in children
Preferred treatment: osmotic, stimulant and stool softener
Refer when:
- feeling weak, dizzy, marked anal pain, blood in stool
Constipation in pregnancy
Preferred choice: Bulk forming and osmotic
- Stimulant in 3rd trimester induces uterine contractions
- Senna enters breast milk causing colic and diarrhoea in infants
What is Diarrhoea
Stool has too much water to reabsorb
- Lasts 5-7 days
- Most infectious in the first 2 days
- Wash hands and wash beddings seperately
- Clean toilets, handles and surfaces frequently
Aetiology of Diarrhoea
- Bacteria
- Virus - rotavirus
- Protozoa and parasites
Symptoms of diarrhoea
- Watery stools
- Abdominal cramps
- Loss of appetite
- Headache/fever
- Associates with nausea and vomiting
When to refer for diarrhoea
Symptoms of severe dehydration: drowsiness, confusion, dry mouth, sunken eyes, passing very little urine, cold hands and feet
Referral period for diarrhoea
Babies = 24 hours
1-3 year olds = 48 hours
Adults = 3 days
Elderly = 48 hours
Oral dehydration therapy
DIAROLYTE Fridge - 24 hrs - Caution in diabetes ( high contents of sugar, salts, potassium ) - Adults = 1 -2 sachets - Children = 1 sachet - Under 2 = 1/2 sachet
Anti-motility drug
LOPERAMIDE
- Improves consistency of stool
- Improves symptoms
- Not licensed for OTC under 12 years
- 2mg capsules
- 2 capsules initially, then 1 capsule after each loose stool
- Max. dose = 16mg/day
- Susceptible to abuse (causes heart problems)
Bismuth salicylate
- For heart burn, indigestion and upset stomach
- Over 16 years
- Side effects: blackened stools and tongue
Kaolin and Morphine
Kaolin absorbs water to bulk stool
Morphine slows gut motility
- Use over age of 12
- Potential to abuse
