Constipation & Diarrhoea Flashcards
What is the Bristols Stool chart?
It is a table used for patients to be able to describe their faeces, from type 1 (constipated) to type 7 (liquid, can be inflammation)
What determines if someone is experiencing functional constipation?
Must have 2 of the following for at least 3 months:
- Straining more
- Lumpy or hard stools
- Feeling of incomplete evacuation
- Sensation of a blockage
- Manual movements needed to help defecate
- <3 bowel movements a week
Why is constipation more common in females?
Because during pregnancy there is slower movements of food through her intestines
How are hard stools formed in the colon?
Altered movements in the colon means that more fluid is reabsorbed from the solid waste, making stools hard. They also remain in the colon longer.
Longer the transit time = harder the stools
What can contribute to constipation?
- Lack of fibres
- Low fluid intake
- Sedentary lifestyle
- Pregnancy
- Medications - opioids, antidepressants, Ca2+ supplements, anti-epileptics
What is an anal fissure?
A small tear around the anus which ends up bleeding.
What are haemorrhoids (piles)?
A condition where the blood vessels around the anus become swollen and large, causing obstructions.
What is faecal incontinence?
Large stools getting impacted and few soft stools coming out around the large stool –> causing diarrhoea symptoms
When do you refer a patient who is experiencing constipation?
- If it has been for > 2 weeks
- Pain on passing stool
- Blood present
- Suspected laxative abuse
- Weight loss
- Nausea/vomiting present
What problems can occur due to laxative abuse?
- Dehydration
- Damage to digestive system
- Chronic constipation
- Damage to nerves of colon
- Electrolyte imbalance, mineral deficiencies
What lifestyle advice can you give for someone experiencing constipation?
- Increase fluid intake
- Increase fibres
- Review medicines
- Exercise
How do insoluble fibres (e.g. oats/fruits) work?
They attract water into the stool & make them softer to pass.
How do soluble fibres (e.g. nuts/wholegrain foods) work?
They dissolve to create a gel to improve digestion.
What are some examples of bulk forming laxatives?
- Isphagula husk
- Sterculia
- Methylcellulose
How do bulk forming laxatives work?
They retain water in the gut, increase faecal bulk & stimulate peristalsis.
What are some examples of osmotic laxatives?
- Lactulose
- Macrogol
- Sorbitol
- Polyethylene glycol
How do osmotic laxatives work?
They increase water absorption in the colon, increase faecal bulk & stimulate peristalsis.
What are some examples of stimulant laxatives?
- Senna
2. Bisacodyl
How do stimulant laxatives work?
They stimulate colonic nerves to increase intestinal motility, as well as peristalsis.
What is a person as risk of if they frequently use stimulant laxatives?
Risk of fluid/electrolyte imbalances
What are some examples of stool softeners?
- Glycerol
- Docusate sodium
- They are act as stimulants
How do stool softeners work?
They reduce surface tension of contents by allowing fat/fluids to penetrate, emulsify & soften stools.
Which laxative is only used in women?
Prucalopride 2mg
- Used if other agents have failed
When do you refer a child when they are experiencing constipation?
- Feeling weak/dizzy
- Anal pain
- Blood in stools
What 2 laxatives are preferred in pregnancy?
- Bulk forming - isphagula husk, sterculia
- Osmotics - lactulose, macrogols
- Fibogel (stimulant) can also be used
What causes diarrhoea?
Too much water present in the stool which the body cannot fully reabsorb
What can cause diarrhoea?
- Bacteria - salmonella, h.pylori, E.coli
- Viruses
- Protozoa/parasites
- Other e.g. emotional upset, anxiety, medications, caffeine, alcohol
What are the symptoms of diarrhoea?
- Watery stools
- Abdominal cramps
- Loss of appetite
- Headache/fever
- Associated with nausea/vomiting
What differential diagnosis can be associated with diarrhoea?
- IBD
- Faecal impaction - stool seepage
- Allergies
- IBS
When do you refer someone who is experiencing diarrhoea?
- Confusion/drowsiness
- Passing little urine
- Cold hands/feet
- Dry mouth or sunken eyes
- If they have come back form holiday & it has not gone away
- Babies/children/elderly
What is the 1st line treatment for diarrhoea?
Oral rehydration therapy - dioralyte sachets
1-2 sachets after each loose stool.
How is loperamide given for diarrhoea?
4mg initially, then 2mg after each loose stool.
No more than 16mg a day.
