Constipation & Diarrhoea

Question 1

What is the Bristols Stool chart?

Answer 1

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)

Question 2

What determines if someone is experiencing functional constipation?

Answer 2

Must have 2 of the following for at least 3 months:

1. Straining more
2. Lumpy or hard stools
3. Feeling of incomplete evacuation
4. Sensation of a blockage
5. Manual movements needed to help defecate
6. <3 bowel movements a week

Question 3

Why is constipation more common in females?

Answer 3

Because during pregnancy there is slower movements of food through her intestines

Question 4

How are hard stools formed in the colon?

Answer 4

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

Question 5

What can contribute to constipation?

Answer 5

1. Lack of fibres
2. Low fluid intake
3. Sedentary lifestyle
4. Pregnancy
5. Medications - opioids, antidepressants, Ca2+ supplements, anti-epileptics

Question 6

What is an anal fissure?

Answer 6

A small tear around the anus which ends up bleeding.

Question 7

What are haemorrhoids (piles)?

Answer 7

A condition where the blood vessels around the anus become swollen and large, causing obstructions.

Question 8

What is faecal incontinence?

Answer 8

Large stools getting impacted and few soft stools coming out around the large stool –> causing diarrhoea symptoms

Question 9

When do you refer a patient who is experiencing constipation?

Answer 9

1. If it has been for > 2 weeks
2. Pain on passing stool
3. Blood present
4. Suspected laxative abuse
5. Weight loss
6. Nausea/vomiting present

Question 10

What problems can occur due to laxative abuse?

Answer 10

1. Dehydration
2. Damage to digestive system
3. Chronic constipation
4. Damage to nerves of colon
5. Electrolyte imbalance, mineral deficiencies

Question 11

What lifestyle advice can you give for someone experiencing constipation?

Answer 11

1. Increase fluid intake
2. Increase fibres
3. Review medicines
4. Exercise

Question 12

How do insoluble fibres (e.g. oats/fruits) work?

Answer 12

They attract water into the stool & make them softer to pass.

Question 13

How do soluble fibres (e.g. nuts/wholegrain foods) work?

Answer 13

They dissolve to create a gel to improve digestion.

Question 14

What are some examples of bulk forming laxatives?

Answer 14

1. Isphagula husk
2. Sterculia
3. Methylcellulose

Question 15

How do bulk forming laxatives work?

Answer 15

They retain water in the gut, increase faecal bulk & stimulate peristalsis.

Question 16

What are some examples of osmotic laxatives?

Answer 16

1. Lactulose
2. Macrogol
3. Sorbitol
4. Polyethylene glycol

Question 17

How do osmotic laxatives work?

Answer 17

They increase water absorption in the colon, increase faecal bulk & stimulate peristalsis.

Question 18

What are some examples of stimulant laxatives?

Answer 18

1. Senna

2. Bisacodyl

Question 19

How do stimulant laxatives work?

Answer 19

They stimulate colonic nerves to increase intestinal motility, as well as peristalsis.

Question 20

What is a person as risk of if they frequently use stimulant laxatives?

Answer 20

Risk of fluid/electrolyte imbalances

Question 21

What are some examples of stool softeners?

Answer 21

1. Glycerol
2. Docusate sodium

• They are act as stimulants

Question 22

How do stool softeners work?

Answer 22

They reduce surface tension of contents by allowing fat/fluids to penetrate, emulsify & soften stools.

Question 23

Which laxative is only used in women?

Answer 23

Prucalopride 2mg

• Used if other agents have failed

Question 24

When do you refer a child when they are experiencing constipation?

Answer 24

1. Feeling weak/dizzy
2. Anal pain
3. Blood in stools

Question 25

What 2 laxatives are preferred in pregnancy?

Answer 25

1. Bulk forming - isphagula husk, sterculia
2. Osmotics - lactulose, macrogols

• Fibogel (stimulant) can also be used

Question 26

What causes diarrhoea?

Answer 26

Too much water present in the stool which the body cannot fully reabsorb

Question 27

What can cause diarrhoea?

Answer 27

1. Bacteria - salmonella, h.pylori, E.coli
2. Viruses
3. Protozoa/parasites
4. Other e.g. emotional upset, anxiety, medications, caffeine, alcohol

Question 28

What are the symptoms of diarrhoea?

Answer 28

1. Watery stools
2. Abdominal cramps
3. Loss of appetite
4. Headache/fever
5. Associated with nausea/vomiting

Question 29

What differential diagnosis can be associated with diarrhoea?

Answer 29

1. IBD
2. Faecal impaction - stool seepage
3. Allergies
4. IBS

Question 30

When do you refer someone who is experiencing diarrhoea?

Answer 30

1. Confusion/drowsiness
2. Passing little urine
3. Cold hands/feet
4. Dry mouth or sunken eyes
5. If they have come back form holiday & it has not gone away
6. Babies/children/elderly

Question 31

What is the 1st line treatment for diarrhoea?

Answer 31

Oral rehydration therapy - dioralyte sachets

1-2 sachets after each loose stool.

Question 32

How is loperamide given for diarrhoea?

Answer 32

4mg initially, then 2mg after each loose stool.

No more than 16mg a day.