Constipation & Diarrhoea

Question 1

Why is constipation more common in pregnancy?

Answer 1

Because there is slower movements of food through her intestines

Question 2

What can cause constipation?

Answer 2

Lack of fibre
Low fluid intake
Sedentary lifestyle
Medications - opioids, antidepressants, Ca2+/iron supplements
Pregnancy

Question 3

What is an anal fissure?

Answer 3

A small tear around the anus which ends up bleeding due to constipation

Question 4

What are haemorrhoids (piles)?

Answer 4

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

Question 5

When do you refer a patient who is experiencing constipation?

Answer 5

If it has been for > 2 weeks
Pain on passing stool
Blood present
Suspected laxative abuse
Weight loss
N+V

Question 6

What lifestyle advice can you give for someone experiencing constipation?

Answer 6

Increase fluid intake
Increase fibres - e.g. fruit/oats
Review medicines
Exercise

Question 7

What are some examples of bulk forming laxatives?

Answer 7

Isphagula husk (fybogel)
Methylcellulose
Sterculia

Question 8

How do bulk forming laxatives work?

Answer 8

They retain water in the gut to increase faecal bulk

Question 9

What are some examples of osmotic laxatives?

Answer 9

Lactulose
Macrogol (movicol)
Sorbitol

Question 10

How do osmotic laxatives work?

Answer 10

They increase water absorption in the colon and increase faecal

Question 11

Which 2 types of laxatives are suitable for use in pregnancy?

Answer 11

Bulk-forming and osmotics

Question 12

What are some examples of stimulant laxatives?

Answer 12

Senna
Bisacodyl

Question 13

How do stimulant laxatives work?

Answer 13

They stimulate colonic nerves to increase intestinal motility

Question 14

What time of the day are stimulants taken?

Answer 14

At night

Question 15

Can you give stimulant laxatives in pregnancy?

Answer 15

No

Question 16

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

Answer 16

Risk of fluid/electrolyte imbalances

Question 17

What are some examples of stool softeners?

Answer 17

Docusate sodium
Glycerol

Question 18

How do stool softeners work?

Answer 18

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

Question 19

What causes diarrhoea?

Answer 19

Due to colon unable to absorb enough water/electrolyes, and causing the stool to pass too quickly

Question 20

When do you refer someone who is experiencing diarrhoea?

Answer 20

Passing little urine
Cold hands/feet
Dry mouth
Other signs of dehydration
If they have recently travelled
<3 years old/elderly
Confusion/drowsiness

Question 21

What is the 1st line treatment for diarrhoea?

Answer 21

Oral rehydration therapy - dioralyte sachets

Question 22

Which condition should you avoid giving dioralyte to?

Answer 22

Diabetics, as it contains sugar

Question 23

What age can dioralyte be given to?

Answer 23

Can be given to all age groups

Question 24

How is loperamide given for diarrhoea?

Answer 24

4mg STAT, then 1 capsule after each loose stool

Question 25

What is the max. amount of loperamide which can be taken in a day?

Answer 25

16mg (so 8 capsules max. /day)

Question 26

What age group can you give loperamide to?

Answer 26

> 12 yrs old