Constipation Assessment and OTC Pdts Flashcards
constipation is more commo in ?
Constipation is a symptom.
◦ Establishing the cause is important in correcting.
More common in the elderly – incidence 40% or higher.
Incidence female>male (2.5 fold)
Many patients will self-treat.
Definition of constipation
Definition: ”unsatisfactory defecation – infrequent stools, difficulty passing stools or both”
Infrequent bowel movements
◦ Often use stool frequency of less than 3 stools per week.
Difficulty in passing stools, often with straining
Stool consistency – hard/lumpy
Other symptoms: sensation of incomplete evacuation,
bloating, discomfort
Diagnostic Criteria for Chronic Constipation
ROME IV
Presence of > 2 of the following for last 3 months (onset at least 6 month before dx): Straining Lumpy/hard stools Sensation of incomplete evacuation Sensation of anorectal obstruction/blockage Manual help to facilitate defecation <3 spontaneous bowel movements per week Loose stools not present (could be IBS) NOT IBS symptoms
What is normal bm?
“Normal” frequency can vary from person to person
Having a BM everyday is not always “normal” for every
person.
Constipation is essentially change in bowel habits form what is normal for that person
causes of constipation
Primary constipation:
No identifiable underlying cause
3 types:
◦ Normal transit constipation: no changes in gi transit, most common
◦ Dys-synergic (disordered) defecation: 25%, inability to coordinate muscles involved
◦ Slow transit constipation: slow down GI tract
Causes of constipation
Secondary constipation:
Identifiable underlying cause: ◦ Lifestyle factors ◦ Medical conditions ◦ Medications See Table 1 of handout
What drugs cause constipation?
Calcium supplements, antacids, iron supplements, antihistamines, antidiarrheal agents, dimenhydrinate
Rx: opiods, anticholinergics, ccb, TCA, antidepressent
diuretics, antispasmodics, antipsychotics, antiepileptics
Complications of constipation
Hemorrhoids Fissures Fecal impaction Megacolon Straining—negative effects on cerebral, coronary and peripheral arteries Malnutrition Rare: pelvic organ prolapse in women, very rare - intestinal perforation
Patient Assessment
1) Identify the predominant symptoms.
what q;s would you ask?
◦ Clarify patients definition of constipation.
◦ Determine normal bowel habits.
◦ Frequency/last bowel movement
◦ Duration - distinguish acute vs chronic
Onset abrupt or gradual?
What do you mean by constipation?
What is your normal bowel patterns?
If you pass any stools, can you describe its
consistency and colour? (bristol stool chart)
Type 6-7 diarrhea
Type 4 is ideal
Patient Assessment
◦ Patients description of severity
• mild severe
◦ Other accompanying symptoms:
abdominal pain, bloating, sensation
of incomplete evacuation, straining,
nausea/vomiting, reduced appetite,
weight loss, rectal bleeding
Do you experience any other symptoms?
Patient Assessment
2. Identify possible secondary
causes or aggravating factors
◦ Medical conditions
◦ Identifiable drug causes check for Rx, OTC and natural health products, new additions or changes
◦ Non-drug/lifestyle causes Describe diet/fluid intake
What makes your constipation worse?
Are there any triggers?
Patient Assessment:
3. Assess for “red flags” that require further
assessment
Blood or mucus in stool or rectal bleeding Unexplained iron deficiency anemia Unexplained weight loss >5% Persistent or severe abdominal pain Palpable abdominal mass Fluctuates with diarrhea Sudden acute/severe onset Symptom onset >50 years of age Family history of colon cancer
Patient Assessment
4. Assess what has been tried to help with constipation
(lifestyle, laxatives, etc)?
◦ For how long?
◦ What doses?
◦ How did it work?
◦ Were there any side effects?
Treatment approaches: Non-pharmacologic
diet
how much fiber?
fluid intake?
Diet
High fiber diet:
◦ Target 28 – 38 gm per day
◦ Increase fiber gradually to avoid bloating, cramping
Fluid intake (i.e. 2 - 3 L per day) to complement
increased fiber
Fruit in diet
Prune juice or figs (contain sorbitol – highest
amounts in prunes, also in pears, apples)
Sorbitol is a laxative in fruits
Fibre in the skin
Eating apple with skiin
Treatment approaches: Non-pharmacologic
Lifestyle
Regular exercise
Regular bowel movement
Avoid suppressing urge to defecate
If obese – weight loss will help
If low calorie diet – increase calories
Consider alternative drug if using constipating drug
(if possible)
If underlying medical cause – attempts to correct it
(for example hypothyroidism)
Biofeedback and relaxation training if chronic
constipation
Insoluble: wheat bran, fruits Soluble: beans, lentils Can consder combination Be cautious in pt with IBS Insoluble can cause bloating and abdominal pain
