Constipation (Parts 1 & 2 - COMBINED) Flashcards
2024
Constipation - what are the symptoms commonly experienced by patient?
- Abdominal bloating,
- cramping,
- discomfort, or pain,
- feeling of incomplete evacuation of stool
According to JAMP (2011), suffering from constipation impacts QoL and has been comparable to serious chronic conditions such as ________ and _______.
Osteoarthritis and diabetes.
Aside from symptoms, what are other ways in which healthcare providers will base their definition or diagnosis of constipation?
Based on the number of stools/week.
T/F: Caution should be applied to avoid anticholinergic medications in patients at risk for opioid-induced constipation.
True!
Caution should be applied to avoid anticholinergic medications in patients at risk for opioid-induced constipation due to their potential to exacerbate constipation symptoms.
- Especially important to note for those in palliative care, cancer patients, and the elderly.
How is Constipation typically defined (in general)?
Less than 3 BM per week accompanied by other symptoms including hard stools; feeling of incomplete evacuation; excessive straining; a sense of rectal blockage; and abdominal discomfort, bloating and distention
How is constipation generally defined?
a) Defecation more than 3 times per week
b) Defecation fewer than 3 times per week
c) Defecation exactly 3 times per week
d) Defecation once every 2 days
e) When daily bowel movements (or every other day) is not achieved on a normal basis
b) Defecation fewer than 3 times per week
Some patients incorrectly believe that a daily bowel movement is necessary and that anything less means they are constipated. “Normal” frequencies in BM can range from daily, EOD, to even just 3x per week.
T/F: Individuals have a considerable higher risk of constipation with each advancing state of renal failure and should be monitored carefully.
True!
There are many factors that influence this outcome for those affected with kidney diseases, including:
- Fluid and electrolyte imbalances
- Medications (both the kinds of drugs and the number of medications being used)
- Dietary restrictions
- Decreased mobility and/or ability to complete physical activity
What are some symptoms commonly associated with constipation?
a) Loose stools
b) Feeling of complete evacuation
c) Excessive straining
d) A sense of rectal openness
c) Excessive straining
T/F: Some patients mistakenly believe that a daily bowel movement is necessary.
True!
The most important preventive measure for hemorrhoids is to avoid _____ constipation, which may include hard and infrequent stools.
Chronic
The average number of bowel movements for adults and children 3 years of age and older in the Western world varies from ______ daily to ______ every 3 days.
a) 3; 2
b) 1; 1
c) 3 ; 1
d) 2; 3
c) 3 ; 1
Some patients incorrectly believe that a daily bowel movement is necessary and that anything less means they are constipated. In fact, the average number of bowel movements for adults and children 3 years of age and older in the Western world varies from 3 daily to 1 every 3 days. Each person’s “normal” can vary.
Chronic constipation may lead to serious complications such as _______, fecal impaction, anal ______, ______ , megacolon, and ______ organ prolapse in women.
Obstruction ; [Anal] Fissures; Hemorrhoids
T/F: Constipation can be a symptom secondary to various factors such as drugs or diseases that affect the normal functioning of the gut.
True!
Along with secondary links mentioned, note that constipation that occurs chronically that does not have drug, anatomic or physiologic causes is termed functional or chronic idiopathic constipation.
The Bristol Stool Form Scale (BSFS)
A tool to help patients describe bowel patterns in a way that is more useful for diagnosis and evaluation of treatment
Which types on the Bristol Stool Form Scale indicate constipation?
a) Types 3–4
b) Types 1–2
c) Types 5–7
d) Types 1–3
b) Types 1–2
Which type on the Bristol Stool Form Scale represents the more ideal stool consistency for ease and comfort?
a) Type 1
b) Type 2
c) Type 3
d) Type 4
e) None of the above
d) Type 4
Although Types 3 and Types 4 both consistent of ideal stool consistencies, Type 4 is the one that is smooth and probably the easiest kind to pass.
Approximately ___% of our immune system is located in out gut.
70%
The _______ of different factors within the gastrointestinal (GI) system, such as the ________ muscles in the intestines plays a crucial role in regulating bowel movements.
Interplay ; Smooth
Physiology of the Gut - Constipation: Intestinal Smooth Muscle -
The contraction and relaxation of intestinal smooth muscles are essential for moving ______ and _____ through the ______.
[moving] FOOD and WASTE through the DIGESTIVE TRACT.
Physiology of the Gut - Constipation: Intestinal Smooth Muscle -
________ Nervous System activity stimulates motility, promoting bowel movements.
In contrast, ______ nervous system activity inhibits motility, which can contribute to constipation.
Parasympathetic ; Sympathetic
Physiology of the Gut - Constipation: Intestinal Smooth Muscle -
Parasympathetic Nervous System activity stimulates motility, promoting __________ . In contrast, sympathetic nervous system activity inhibits motility, which can contribute to constipation.
Bowel Movements (BMs)
Physiology of the Gut - Constipation: Intestinal Smooth Muscle -
Parasympathetic Nervous System activity _____ motility, promoting bowel movements.
Stimulates
Physiology of the Gut - Constipation: Intestinal Smooth Muscle -
Parasympathetic Nervous System activity stimulates motility, promoting bowel movements.
In contrast, Sympathetic Nervous System activity ______ motility, which can contribute to constipation.
Inhibits
Physiology of the Gut - Constipation: Intestinal Smooth Muscle - GI Hormones
Various hormones produced in the GI tract regulate ______ and _____.
Digestion and Motility
Physiology of the Gut - Constipation: Intestinal Smooth Muscle - GI Hormones
These hormones influence the movement of food through the digestive system and can affect bowel _______. Imbalances in these hormones may contribute to constipation.
Habits
Physiology of the Gut - Constipation: Intestinal Smooth Muscle - GI Hormones
These hormones influence the movement of food through the digestive system and can affect bowel imbalances. Imbalances in these hormones may contribute to _______.
Constipation
Which of the following statements regarding the timing of the gastro-colic reflex is true?
a) The gastro-colic reflex occurs immediately after the first meal of the day.
b) The gastro-colic reflex typically occurs about 1 hour after consuming food.
c) The most optimal timing for the gastro-colic reflex is approximately 30 minutes after the first meal of the day.
d) The gastro-colic reflex is not influenced by the timing of meals.
c) The most optimal timing for the gastro-colic reflex is approximately 30 minutes after the first meal of the day.
Which division of the autonomic nervous system is responsible for inhibiting gastrointestinal motility and secretion during the “fight or flight” response?
a) Parasympathetic nervous system
b) Sympathetic nervous system
c) Enteric nervous system
d) Somatic nervous system
b) Sympathetic nervous system
Which of the following is NOT a function of the parasympathetic nervous system in regulating gastrointestinal (GI) activity?
a) Stimulating peristalsis
b) Increasing saliva production
c) Relaxing the lower esophageal sphincter
d) Inhibiting gastric acid secretion
d) Inhibiting gastric acid secretion
Which hormone stimulates the secretion of gastric acid and increases gastric motility?
a) Gastrin
b) Secretin
c) Cholecystokinin (CCK)
d) Ghrelin
a) Gastrin
Physiology of the Gut - Constipation: Intestinal Smooth Muscle - Influence of Neurotransmitters…
The gut contains a significant amount of ______, a neurotransmitter involved in regulating mood and behaviour.
Serotonin (also known as 5-HT)
What role does the neurotransmitter, Serotonin (5-HT), have on the GI functions?
- Regulates motility.
- Alterations in serotonin levels or signalling in the gut can impact bowel movements and contribute to constipation.
***Keep this in mind when discussing about diarrhea, as well as IBS, IBD and other related conditions in both this class and in PHAR 123 later on FYI **
In the event of constipation, serotonin levels are usually _______
a) Increased
b) Decreased
b) Decreased 5-HT [serotonin] = Constipation
(increased serotonin is usually affiliated with diarrhea)
Alterations in _______ levels or signalling in the gut can impact bowel movements and contribute to constipation.
Serotonin
Physiology of the Gut via Intestinal Smooth Muscles: Central Nervous System (CNS) ~ e.g., emotions
Emotions and stress can influence GI function through the ________.
Gut-Brain Axis
The Gut-Brain Axis involves _____ communications between the gut and the brain.
Whereas the Gastro-Colic Reflex is a _____, reflexive response triggered by stretching of the stomach, and it does not involve bidirectional communication between the gut and the brain.
Complex ; Simple
Physiology of the Gut via Intestinal Smooth Muscles: ________ ~ e.g., emotions
The CNS can modulate gut motility and sensation, affecting bowel habits. Psychological factors such as anxiety or depression can exacerbate constipation or contribute to its development.
Central Nervous System (CNS)
The CNS can modulate gut motility and sensation, affecting bowel habits. Psychological factors such as anxiety or depression can exacerbate constipation or contribute to its development.
Physiology of the Gut via Intestinal Smooth Muscles: Central Nervous System ~ e.g., emotions
The CNS coordinates how the body system will respond or behave based on the combined information coming in about emotions, movements, thoughts, as well as things like HR, and homeostasis.
Psychological factors such as anxiety or depression can ______ constipation or contribute to its ______.
Promote;
Development
T/F: The gut-brain axis can be influenced by factors like stress, emotions, and dietary choices.
True!
The gut-brain axis is sensitive to various factors such as stress, emotions, and dietary choices, which can influence its function and the communication between the gut and the brain.
What triggers the gastro-colic reflex?
a) Release of neurotransmitters
b) Stretching of the stomach
c) Activation of the vagus nerve
d) Increase in blood glucose levels
b) Stretching of the stomach
The gastro-colic reflex is triggered by the stretching of the stomach when food enters it. This stretching signals the colon to start moving and make room for incoming food.
T/F: The gastro-colic reflex is a complex network of communication involving hormones, neurotransmitters, and nerves.
False!
The gastro-colic reflex is a relatively SIMPLE reflexive response triggered by stretching of the stomach and does not involve the complex network of communication seen in the gut-brain axis.
It primarily involves activation of nerves in the gastrointestinal tract when eating and digesting.
Constipation: Physiology of the Gut:
This reflex involves the stimulation of colonic motility following the consumption of food.
The presence of food in the stomach triggers contractions in the colon, facilitating the movement of waste through the digestive tract. Disruption of this reflex can lead to constipation.
Gastro-Colic Reflex
The gastro-colic reflex is like a signal from your stomach to your colon, telling it to get ready for more food coming down the line. When you eat, your stomach starts to stretch as it fills up. This stretching triggers a reflex that stimulates movement in your colon, which helps push out any waste that’s already there to make room for the new food. It’s like your body’s way of clearing the runway for the next meal!
Some people might have the urge to poop very soon after eating and some people might assume the food they just ate is being immediately evacuated out of them.
Is this a true statement?
No. Even though it might feel like this, it is not true because it takes approx. 1-2 days before food travels through the entire GI tract.
If they poop after eating, it’s likely because they are passing the food that was eaten a few days ago.
The need or urgency to poop shortly after eating a meal is likely associated with the ______.
Gastro-Colic Reflex
(and urgency depending on individual intensities of their reflex system).
What is the most optimal time for the gastro-colic reflex to occur from the time of eating first meal of the day?
30 minutes after first meal of the day is the most optimal for the gastro-colic reflex.
Patient L.T. has a spinal cord injury at the thoracic level presents with constipation. Which of the following mechanisms is primarily responsible for the constipation in this patient?
a) Increased parasympathetic activity
b) Decreased sympathetic activity
c) Impaired serotonin signalling
d) Disruption of the gastro-colic reflex
d) Disruption of the gastro-colic reflex
Spinal cord injuries can disrupt neural pathways involved in the gastro-colic reflex, leading to impaired colonic motility and constipation.
A 50-year-old patient with a history of depression presents with chronic constipation. Which of the following factors is most likely involved in the pathophysiology of constipation in this patient?
a) Increased parasympathetic activity
b) Decreased sympathetic activity
c) Dysregulation of GI hormones
d) Impaired gastro-colic reflex
c) Dysregulation of GI hormones
Depression can affect the secretion and function of GI hormones, leading to alterations in gut motility and contributing to constipation.
Constipation & the Physiology of the Gut: Understanding the different Nervous Systems involved in the GI tract….
__________ - Stimulates gut motility and promotes bowel movements.
________ - Inhibits gut motility and therefore illicit constipation.
_______ - triggers somatic states based on rounding up the information gathered from controlling thought, movement, and emotion, as well as breathing, heart rate, hormones, and body temperature and coordinates the activity within the body.
Parasympathetic Nervous System;
Sympathetic Nervous System;
Central Nervous System
Which of the following is a characteristic of the gut-brain axis?
a) Unidirectional communication from the gut to the brain only
b) Simple reflexive response triggered by stomach stretching
c) Involvement of hormones, neurotransmitters, and nerves
d) Activation primarily by psychological stressors
c) Involvement of hormones, neurotransmitters, and nerves
The gut-brain axis involves complex communication between the gut and the brain, including the release of hormones, neurotransmitters, and activation of nerves to influence various physiological functions.
Physiology of the Gut via Intestinal Smooth Muscles:
Which of the following nervous systems is responsible in stimulating motility and therefore promoting bowel movements?
a) Central Nervous System
b) Enteric Nervous System
c) Parasympathetic Nervous System
d) Sympathetic Nervous System
e) Both b and c
f) Both b and d
c) Parasympathetic Nervous System
- Stimulates Motility and therefore promotes BMs
Physiology of the Gut via Intestinal Smooth Muscles:
Which of the following nervous systems is responsible in the inhibition of gut motility and therefore influencing constipation?
a) Central Nervous System (CNS)
b) Enteric Nervous System
c) Parasympathetic Nervous System
d) Sympathetic Nervous System
e) Both b and c
f) Both b and d
d) Sympathetic Nervous System
“These mechanisms, being involuntary in nature, are under the control of the sympathetic nervous system; consequently the primary cause of the constipation must be sought for in some inhibitory influence acting on any or all of the mechanisms referred to.”
doi:10.1001/jama.1900.24610210012001c
T/F: Drugs that block muscarinic receptors in the GI tract are likely to increase gastrointestinal motility.
True!
Muscarinic receptors are a type of receptor that responds to the neurotransmitter acetylcholine, which is released by nerves in the GI tract. Activation of muscarinic receptors by acetylcholine stimulates smooth muscle contraction and promotes GI motility.
Physiology of the Gut - Constipation: Intestinal Smooth Muscle -
Parasympathetic Nervous System activity stimulates motility, promoting bowel movements.
In contrast, Sympathetic Nervous System activity inhibits motility, which can contribute to _______.
Constipation
The gut-brain axis can be thought of like a phone line them, allowing them to ______ messages.
This connection influences how your gut works, like how it _______, absorbs nutrients, and even affects your ______ and emotions.
So, basically, it’s the link between your gut and your brain that helps them communicate and affect each other’s functions.
EXCHANGE messages;
DIGEST FOOD;
Affects your MOOD and EMOTIONS.
Patient “J.J.” recently started taking a new medication and complains of constipation. The medication is known to have anticholinergic effects.
Which of the following mechanisms is likely responsible for the constipation seen in this patient?
a) Increased parasympathetic activity
b) Decreased sympathetic activity
c) Inhibition of GI hormones
d) Suppression of the gastro-colic reflex
e) Impacts on the gut-brain axis
d) Suppression of the gastro-colic reflex
Anticholinergic medications inhibit parasympathetic activity, leading to decreased GI motility and suppression of the gastro-colic reflex, which can result in constipation.
The gastro-colic reflex is a natural physiological response that occurs after eating, particularly after the first meal of the day.
Why is 30 minutes after consuming first meal of the day the most optimal in most cases?
Because the stomach is filling up with food, and the reflex helps to stimulate movement in the colon, aiding in the propulsion of waste and making room for incoming food.
Ada presents with chronic constipation and reports a history of frequent use of antacid medications for heartburn. Which of the following mechanisms is likely contributing to the constipation in this patient?
a) Enhanced parasympathetic activity
b) Reduced sympathetic activity
c) Dysregulated gut-brain axis
d) Excessive serotonin production
e) Supression of the gastro-colic reflex
c) Dysregulated gut-brain axis
Prolonged use of antacid medications can disrupt the gut-brain axis, affecting communication between the gut and the central nervous system, which may lead to constipation.
The gut-brain axis influences:
a) Only digestion and nutrient absorption
b) Mood and emotions, but not gastrointestinal functions
c) Various physiological functions in both the gut and the brain
d) None of the above
c) Various physiological function in both the gut and the brain
The gut-brain axis influences not only digestion and nutrient absorption but also mood, emotions, immune function, and other physiological processes in both the gut and the brain.
A patient with a history of irritable bowel syndrome (IBS) presents with alternating episodes of constipation and diarrhea. Which of the following mechanisms is implicated in the pathophysiology of IBS-related constipation?
a) Increased sympathetic activity
b) Dysregulated gut-brain axis
c) Hyperactive gastro-colic reflex
d) Enhanced serotonin production
b) Dysregulated gut-brain axis
In patients with IBS, the gut-brain axis is often dysregulated, leading to alterations in GI motility and symptoms such as constipation or diarrhea.
IMPORTANT to remember for IBS discussion and IBD section in 123 ***
Constipation can be caused by drugs that:
a) Increase parasympathetic activity
b) Inhibit serotonin reuptake
c) Stimulate smooth muscle contraction
d) Block opioid receptors in the gut
d) Block opioid receptors in the gut
When opioid receptors in the gut are activated, they inhibit the release of neurotransmitters such as acetylcholine, which are responsible for promoting GI motility and secretion. This inhibition slows down the movement of food and waste through the GI tract, resulting in constipation.
Conversely, blocking opioid receptors in the gut with certain drugs, such as opioid receptor antagonists or partial agonists, can counteract the constipating effects of opioids
T/F: Nearly twice as many women suffer from digestive health issues on a weekly basis compared to men.
True!
The interplay of hormonal, anatomical, dietary, psychosocial, and reproductive factors can all contribute to the higher prevalence of digestive health issues in women compared to men.
T/F: One non-pharmacological treatment considerations for constipation can include increasing calories consumed in a day if low caloric intake
TRUE!
This helps improve colonic transit for those who have a lower caloric daily intake.
Fibre is recommended as a first-line therapy for patients with hemorrhoids primarily because it helps to:
a) Reduce inflammation
b) Improve stool consistency
c) Increase blood flow
d) Enhance intestinal absorption
b) Improve stool consistency
There is moderate-quality evidence to support the use of _______ in the medical treatment of symptomatic hemorrhoids.
Dietary fibre
(FYI: remember this is NOT the same as the use of bulk-forming laxatives like BeneFibre for example)
What should be ruled out if a patient on opioids has not passed a stool in more than 3 days?
A) Fecal impaction
B) Intestinal obstruction
C) Rectal prolapse
D) Perforated bowel
A) Fecal impaction
Women aged 19-50 years are recommended to consume _______ grams of dietary fibre daily.
25 grams
The recommended daily intake of dietary fibre for women aged 51 and older is:
a) 25 grams
b) 21 grams
c) 28 grams
d) 30 grams
b) 21 grams
What is the recommended daily intake of dietary fibre for pregnant women?
a) 25 grams
b) 28 grams
c) 30 grams
d) 38 grams
b) 28 grams
What is the recommended daily intake of dietary fiber for breastfeeding women?
a) 25 grams
b) 28 grams
c) 29 grams
d) 30 grams
c) 29 grams
The daily recommended dietary fibre intake for adult MEN aged 19-50 years is _______ grams.
38 grams
Men aged 51 and older are advised to have _______ grams of dietary fibre in their daily diet
30 grams
To minimize problems with bloating and abdominal discomfort associated with fibre intake, it is recommended to slowly _______ fibre intake.
Increase
Fibre may help improve constipation, pruritus due to fecal soilage, and _______ related to hemorrhoids.
[Rectal] Bleeding
Which of the following demographics has the highest recommended daily intake of dietary fibre for men in Canada?
a) Pregnant women
b) Adult men ages 19-50
c) All adults 51+ yo
d) Breastfeeding women
e) Adult women ages 15-50
d) Breastfeeding women — they are recommended to have 29 grams of dietary fibre in daily intake.
The recommended daily intake of dietary fibre for adults in Canada depends on their _______ and/or ______.
Age and/or State of health.
T/F: Peripheral acting mu-opioid receptor antagonists are considered second-line treatment for opioid-induced constipation if traditional laxatives fail.
True!
Peripheral acting mu-opioid receptor antagonists are considered second-line treatment for opioid-induced constipation if traditional osmotic and stimulant laxatives fail to provide adequate relief. These agents work by blocking the effects of opioids in the gastrointestinal tract, thereby alleviating constipation. They are particularly useful in patients who require high-dose opioids for pain management.
The concept of ________ in the gut refers to the process by which the gastrointestinal (GI) tract absorbs and reabsorbs fluids to maintain fluid balance within the body.
- This process is crucial for preventing dehydration and ensuring the proper functioning of various physiological processes.
Fluid Recovery
Fluid Recovery refers to how the GI tract _____ and ______ fluids to maintain fluid balance within the body. This process is crucial for preventing dehydration and ensuring the proper functioning of various physiological processes.
Absorbs and reabsorbs
In fluid recovery, the GI Tract absorbs and reabsorbs fluids to maintain fluid _____ within the body.
This process is crucial for preventing dehydration and ensuring the proper functioning of various physiological processes.
[Fluid] Balance
Why is Fluid Recovery an important process? (3)
- Maintains fluid balance
- Prevents dehydration
- Ensures proper functioning of various physiological processes
In the gut, fluids enter the ______ every day, which is the first part of the _____ intestine, from both dietary intake and intestinal secretions.
Duodenum; Small
In the gut, fluids enter the duodenum on a daily basis, which is the first part of the small intestine, from two main sources.
List the TWO (2) Sources of Fluid in the Fluid Recovery Process.
1) Dietary Intake (2L)
2) Intestinal Secretions (7L)
T/F: Among the two sources in fluid recovery, intestinal secretions account for the majority of fluid entering the body as it makes up for approximately 9L of the fluid entered daily.
FALSE.
While the intestinal secretions does contribute to the majority of fluid entering the duodenum, the daily contributions totals to around 7 L per day (not 9)
(When accounting for the dietary fluid source giving approx 2L daily, the total amount of fluid being sourced daily equals to 9)
Which of the following statements is INCORRECT in regards to the Fluid Recovery Process in the Gut?
a) 9 L of fluid enters the duodenum/day
b) There are two sources of fluid: dietary intake (2L) and the intestinal secretions (7L)
c) Once in the duodenum, these fluids undergo absorption along the length of the small and large intestines. Small intestines absorbs the majority of the incoming fluid and is responsible for absorption of nutrients and the fluid balance process.
d) Approximately 50 mL of fluid is excreted in the stool per day, contributing to its consistency and aiding in the elimination of waste from the body.
d) Approximately 50 mL of fluid is excreted in the stool per day, contributing to its consistency and aiding in the elimination of waste from the body IS FALSE…
- After the absorption process, the remaining fluid, along with indigestible materials and waste products, moves through the colon to form feces.
- Approximately 150mLs of the fluid is excreted in the stool each day (NOT 50 mLs)
Fluid recovery in the gut involves the absorption of fluids from dietary intake and intestinal secretions, primarily by the small and large intestines.
This process ensures the maintenance of fluid balance within the body and facilitates the absorption of nutrients while allowing for the elimination of waste products through ______.
Stool formation
Fluid Recovery in the Gut:
What is the total volume of fluid entering the duodenum daily?
a) 5 litres
b) 7 litres
c) 9 litres
d) 10 litres
c) 9 L
Fluid Recovery in the Gut:
How much fluid entering the duodenum daily is from dietary intake?
a) 1 L
b) 2 L
c) 3 L
d) 4 L
b) 2 L
Fluid Recovery in the Gut:
How much fluid is absorbed by the small intestine daily?
a) 150 mL
b) 850 mL
c) 1 L
d) 2 L
e) 7 L
f) None of the above
f) None of the above!
In the fluid recovery process in the gut, the small intestine will absorb approx. 8L per day.
Fluid Recovery in the Gut:
Approximately how much fluid is absorbed by the large intestine daily?
a) 8 L
b) 850 mL
c) 500 mL
d) 1 L
b) 850 mL
T/F: Fluid recovery in the gut primarily involves the excretion of excess fluids to maintain electrolyte balance.
False!
Fluid recovery in the gut primarily involves the ABSORPTION of fluids rather than excretion to maintain fluid balance within the body.
The main function of the GI tract, particularly the _____ intestine, is to absorb nutrients, water, and electrolytes from the ingested food and fluids.
Small
Carrying off from their counter intestine, the ______ intestine, particularly the colon, further absorbs water and electrolytes from the remaining indigestible materials.
This absorption process helps in concentrating the stool and conserving water within the body.
Large
While a ____ amount of fluid is excreted in the stool, the main function of the GI tract is to absorb water and ______ to prevent dehydration and maintain homeostasis.
Small [amount]; Electrolytes
Which of the following statements accurately describes the order of processes in the fluid recovery in the gut?
a) 9L of Fluid enters the duodenum from dietary intake (2 L) and from intestinal secretions (7 L) -> Absorption of fluid by the small intestine (8 L) -> Absorption of fluid by the large intestine (850 mL) -> Excretion of fluid in the stool (150 mL).
b) 9L of Fluid enters the duodenum from dietary intake (7 L) while 2L from intestinal secretions -> Absorption of fluid by the large intestine (850 mL) -> Absorption of fluid by the small intestine (8 L) -> Excretion of fluid in the stool (150 mL).
c) 9 L of Fluid enters the duodenum from dietary intake (2 L) and from intestinal secretions (7 L) -> Absorption of fluid by the large intestine (850 mL) -> Absorption of fluid by the small intestine (8 L) -> Excretion of fluid in the stool (150 mL).
d) 9L of Fluid enters the duodenum from dietary intake (7 L) and from the intestinal secretions (2 L) -> Absorption of fluid by the small intestine (8 L) -> Absorption of fluid by the large intestine (850 mL) -> Excretion of fluid in the stool (150 mL).
a) 9L of Fluid enters the duodenum from dietary intake (2 L) and from intestinal secretions (7 L) -> Absorption of fluid by the small intestine (8 L) -> Absorption of fluid by the large intestine (850 mL) -> Excretion of fluid in the stool (150 mL).
T/F: Adequate fluid consumption is necessary during pregnancy and breastfeeding to prevent dehydration and stimulate milk production.
True!!
Which type of fibre has better evidence for improving constipation symptoms?
a) Insoluble fibre
b) Soluble fibre
c) Bran fibre
d) Wheat fibre
b) Soluble fibre
Soluble fibre has better evidence than insoluble fibre.
A 45-year-old individual presents with complaints of alternating episodes of constipation and diarrhea, accompanied by abdominal pain and bloating. They report that their bowel movements often resemble soft blobs with clear-cut edges. Upon further examination, they are diagnosed with irritable bowel syndrome (IBS). What type on the Bristol Stool Form Scale is most likely to be observed in this patient?
a) Type 1
b) Type 3
c) Type 5
d) Type 7
c) Type 5
List some examples of foods that contain high soluble fibres.
- Beans (black beans, kidney beans)
- Brussel sprouts
- Sweet potatoes
- Broccoli
- Apple
- Avocados
- Pears
- Flax seeds
What is the recommended daily target ranges for fibre intake in young adults?
a) 10-20 grams
b) 15-25 grams
c) 25-38 grams
d) 30-40 grams
c) 25-38 grams
________ can be particularly applicable in settings such as nursing homes and pediatric care, where individuals may face challenges with bowel function due to factors such as aging, medical conditions, or developmental issues.
Bowel Retraining
Bowel Re-Training
A 55-year-old patient has difficulty establishing a regular bowel routine and often ignores the urge to defecate. Which non-pharmacologic therapy should be emphasized?
a) Increase caloric intake
b) Encourage regular bowel regimen
c) Consume a high-fibre diet
d) Spend prolonged periods of time at the toilet
b) Encourage regular bowel regimen
this is especially important for older people as they age
Patients should attempt to have a bowel movement at the same time each day especially after breakfast, since colonic activity is highest at that time. Encourage patients to heed the urge to defecate and discourage them from spending prolonged periods of time at the toilet.
Opioid-induced constipation is a risk in patients with a high burden of __________ medications and high/chronic opioid doses.
anti-cholinergic
Drug-Induced Constipation:
What are the two different situations to be considered?
Beforehand & After-the-Fact.
Drug-Induced Constipation:
J.D. is a young adult who just had wisdom teeth surgery at 6 AM. He’s been prescribed Tylenol #3 (codeine/acetaminophen) QID. He took his first dose at around 2 PM… He normally has daily BMs after suppertime.
How much Senokot should he take?
a) 1 tablet of regular strength (8.6mg) on night 1, then increase to 2 tabs HS for the rest of the week/therapy.
b) 1-2 tablet(s) of regular (8.6-17.2mg) on night 1, then go to 2 tabs HS for the rest of the nights.
c) 2 tablet of the regular strength (8.6mg x 2) on night 1, then go to 4 tablets (8.6mg x 4) HS for the rest of the time
d) 1 tablet of the extra strength (17.2mg) on night 1, then can go 1-2 tablet(s) of extra strength (17.2-34.4mg) HS thereafter depending on ability to do BMs.
a) 1 tablet of regular strength (8.6mg) on night 1, then increase to 2 tabs HS for the rest of the week/therapy.
- This scenario is a Beforehand Drug-Induced Constipation scenario.
- If patient previously had daily BMs after supper AND had taken his first T3 dose at 2pm today, we will want to get him to take 1 regular strength blindly then take 2 tabs HS for the rest of the nights blindly and getting ahead of the game instead of catch-up.
Drug-Induced Constipation:
Tink is a teenage boy who had emergency tooth extraction late last night at around midnight at the hospital. The discharge nurse gave Tink a T3 to take before heading home at around 6:30am and also sent him a RX for home QID use.
How much Senna is recommended if we are considering beforehand situations in this case? Need to know this!
a) 1 tablet of regular strength (8.6mg) on night 1, then increase to 2 tabs HS for the rest of the week/therapy.
b) 2 tablet(s) of regular (8.6 x 2 ) on night 1, then stay on 2 tabs HS for the rest of the nights.
c) 2 tablet of the regular strength (8.6mg x 2) by lunch time. If this lunch time senna works, wait until the NEXT evening to take 2 tabs HS going forward.
d) 2 tabs of regular (8.6 x 2) before noon, then either use an enema or dulcolax suppository for HS to make sure a BM occurs, then go to 2 tabs HS for the rest of the therapy starting HS dosing on Night 2.
b) 2 tablet(s) of regular (8.6 x 2 ) on night 1, then stay on 2 tabs HS for the rest of the nights.
This is still an example of beforehand situation.
Drug-Induced Constipation:
Kendra is a 25-yo female who just had a root canal at 9am done and is in a lot of pain so was prescribed T3s. She took her first T3 at 2pm on Monday and normally poops after suppertime but she can’t really eat much right now. She continues to take T3s… She comes to the pharmacy on Wednesday at 6pm asking for help because she hasn’t had a BM since Sunday PM… She feels backed up but no stomach pain or anything like that.
How much Senna is recommended if we are considering the circumstances AND the time you are seeing her?
a) Enema or Dulcolax suppository as soon as they get home that night, then go to 1-2 tab(s) of Senokot regular HS going forward until T3s are done.
b) Take 1 tab of regular (8.6mg) at 11pm, see if any success by morning. If it works, increase to 2 tabs (8.6mg x 2) HS until T3s are done.
c) Take 2 tablets of the regular strength (8.6mg x 2) by 10pm that night OR an enema OR Dulcolax suppository. Then try 2 tabs of Senokot at 10am next day and 2 tabs HS. If this works, then reduce dosing to just 2 tabs HS by night 3 (since starting laxative treatment) until T3s are done.
d) Take 2 tabs at 11pm that evening. If no success by AM, should take 2 tabs at 11am, then use an enema or a Dulcolax suppository HS.
d) Take 2 tabs at 11pm that evening. If no success by AM, should take 2 tabs at 11am, then use an enema or a Dulcolax suppository HS.
This is an example of After-the-Fact treatment
If patient was experiencing mild cramping when they saw you, option a would have been the choice to run with.
Shawn is suffering from drug-induced constipation since starting his Wellbutrin XL approx. two weeks ago…
- His BM are limited. His stool descriptions match to Type 1 of the Bristol scale.
- He reports to having maybe 2 BM each week since this started
Pharmacist has advised Shawn to complete an enema as soon as he gets home, and advises him to start taking Senna 17.2mg HS after the enema. If he successfully has a BM by the next AM (not including the enema, if applicable), he can continue to take Senokot (8.6-17.2mg) HS going forward.
What is wrong with the advice given by pharmacist?
Senokot is meant for acute treatment and not recommended to be used long-term due to dependency issues. Wellbutrin XL has anticholinergic properties and if continues to take, could have constipation for a while.
- Wellbutrin XL is not the same as a short-term T3 use.
- Pharmacist could advise patient to follow the regimen they told except modify to say should be only for a few days, stop senna and see if able to do BM on own while advising patient on prune and increased dietary fibre intake
- Consider bulk-forming agents like psyllium if need for longer term usage
- Consult MD to switch medication and/or dosing of Wellbutrin XL if constipation does not improve
A 40-year-old individual complains of infrequent bowel movements and difficulty passing stool. They have a sedentary lifestyle and consume a low-fibre diet.
What non-pharmacologic therapy would be most appropriate to recommend?
a) Increase caloric intake
b) Consume a high-fibre diet
c) Encourage regular bowel regimen
d) Spend prolonged periods of time at the toilet
b) Consume a high-fibre diet
… recommended to improve colonic transit and alleviate constipation symptoms.
Although encouragement of regular bowel regimen is a non-pharmacological option for adults with constipation, note how it was mentioned they already have a low-fibre diet.
Mild-to-Moderate exercise is also a good thing to add too.
Which of the following is NOT recommended as a non-pharmacological therapy for constipation in children?
a) Increasing fluid intake
b) Increasing fruit and vegetable intake
c) Using fibre supplements
d) Limiting fruit juice intake
c) Using fibre supplements
Current evidence does not support fibre supplements in treatment of pediatric functional constipation. Rather, increased fluid, fruit and vegetable intake may reduce the risk of functional constipation.
What is the recommended daily dietary fibre level for children aged 3–7 years?
≥ 10 g for children 3–7 years of age
What is the recommended daily dietary fibre level for children aged 8–14 years?
a) ≥5 g
b) ≥10 g
c) ≥15 g
d) ≥20 g
c) ≥ 15 g
Aim for a daily dietary fibre level:
- ≥15 g for children 8–14!!
(Ages 3-7 is 5 grams less)
Which type of juice is recommended for infants aged 6–12 months to help alleviate constipation?
a) Orange juice
b) Grape juice
c) Prune juice
d) Cranberry juice
c) Prune juice
Juices that contain sorbitol (e.g., prune, apple and pear) can increase the frequency of bowel movements and water content of stools.
Obviously, other demographics, we would prefer the actual fruit to juice, but infants can’t eat prunes yet.
Which product can be used for both constipation and is also regarded to be a prebiotic?
Inulin
T/F: Consuming apples, pears, and prunes can help alleviate constipation due to their high sorbitol content.
True!
For children aged 1–6 years, what is the recommendation regarding fruit juice intake?
a) No restriction
b) Limit fruit juice intake
c) Encourage fruit juice intake
d) Substitute fruit juice with water
b) Limit fruit juice intake
Kids can be picky and we want to make sure they gets fluids in them. It’s okay to give them juice just make sure to limit the amount they consume.
Which types on the Bristol Stool Form Scale indicate diarrhea and urgency?
a) Types 3–4
b) Types 1–2
c) Types 5–7
d) Types 6–7
c) Types 5–7
Which age group of children should limit fruit juices to manage constipation?
a) 1-6 years
b) 3-7 years
c) 8-14 years
d) 7-18 years
a) 1-6 years
Increasing fecal mass/volume = _______
Stimulation of peristalsis
(AKA: GI Motility)
Abby is a 30-yo female. She currently takes amitriptyline and an oral birth control.
For the past 5 days, she has struggled to feel a sense of emptying when she takes her daily BMs. She has had a combination of diarrhea and constipation. Each occasion this week, she has had cramping and has been straining a lot when sitting on the toilet. She says her poop looks like sausages but are lumpy when they are more solid forms.
She has been eating normally and drinking a lot of water but has reported to have lost 6 lbs so far. She reports this happens to her at least 2x a month since high school.
What would you recommend for her? What could be happening?
Refer to MD
- Alternating between constipation and diarrhea can be indicative of IBS, IBD, or a GI infection, for instance.
- We do not know how significant (% wise) is her weight loss; however, the fact she has lost weight despite continuing to eat and drink water and the BMs is a concern for the weight loss
- Amitriptyline can also cause constipation as TCAs have anticholinergic properties
Which of the following bulk-forming laxatives is one that are not just available at pharmacies, and is reported to have side effects such as:
- Diarrhea,
- Bloating,
- Flatulence
Bran!
Unlike Metamucil (psyllium), BeneFibre (Ilium), and Prodiem (calcium polycarbophil - GREEN) OTC products, CPS indicates that Bran can cause some diarrhea, which is not as common with the OTC products.
What is the Onset of Action for Bran?
a) 12-72 hours
b) 24-72 hours
c) 3-5 days
d) Up to a week
c) 3-5 days
Bulk-Forming Agents used to treat constipation is primarily used for:
a) Acute relief
b) Prevention
*NEED TO KNOW THIS!!!**
b) Prevention
Why is it important to administer bulk-forming agents like Metamucil and BeneFiber with 250 mL or more of water or juice?
a) To enhance absorption of the laxative into the bloodstream
b) To minimize the risk of gastrointestinal irritation
c) To prevent esophageal obstruction and fecal impaction
d) To increase the laxative’s effectiveness in stimulating bowel movements
e) It is the only way the medication can be ingested in the body and able to travel through the GI tract
c) To prevent esophageal obstruction and fecal impaction
Without sufficient fluid intake, the laxative may form a thick, gel-like mass (especially for psyllium) in the esophagus, leading to difficulty swallowing or obstruction. Additionally, proper hydration helps facilitate the passage of the laxative through the digestive tract, reducing the risk of fecal impaction.
What is the Onset of Action of OTC Bulk-Forming Laxatives (e.g., psyllium, inulin, Calcium polycarbophil - green)?
12-72 hours
Which of the following cases of constipation would products like Metamucil (psyllium) or BeneFibre (inulin ) may not be beneficial for?
a) Max, a 30-year-old male who suffers from chronic functional constipation
b) Gina, a 21-year-old female who is 3 days postpartum who gave birth to a beautiful, healthy boy via C-section.
c) Adam, a 55-year-old male with Parkinson’s Disease who takes a few medications, including benztropine.
d) Lily, a 52-year-old female with dyslipidemia (i.e., Hyperlipidemia) who takes atorvastatin 40mg QD
e) Both a and b
f) Both b and c
g) None of the above - they are all candidates to use bulk-forming agents.
f) Both b and c
RXFiles (2023) indicates that bulk-forming laxatives might not serve to be beneficial to individuals w/ constipation
due to slow-transit, pelvic floor
dysfunction or medication-induced.
b) Gina is 3 days postpartum… Pregnancy and child-birth (natural or C-section) can cause for pelvic floor dysfunction.
c) Adam has Parkinson’s Disease and takes benztropine, which is an example of an anticholinergic - which can induce constipation.
What the difference between the blue-labeled Prodium and green-labeled Prodium products?
** Sneaky little bish… Need to know because most patients don’t look at the difference ***
There IS a difference!!
- Prodium in the blue packaging = Sennosides 15mg and for ACUTE, Overnight RELIEF
- Prodium in green packaging = Calcium polycarbophil and is for PREVENTION
T/F: Both Prodium versions [blue vs. green] have different onset of actions but are both classified as bulk-forming agents.
False! Do NOT mix these two up!
- Prodium [blue] is Sennoside therefore is classified as a STIMULANT laxative and meant for acute relief.
- Prodium [green] is calcium polycarbophil which is classified as a bulk fibre therapy (Onset of action: Can be up to 5 days) and for preventative purposes.
Metamucil vs Benefiber… Which is more effective?
Metamucil
- Psyllium has more efficacy data
How common is psyllium-induced obstruction?
(answer is not a specific number FYI)
Low… Can be considered extremely rare.
In such reported cases, most times, drug was blamed for it but it’s more likely that the psyllium just added to whatever was obstructed in there in the first place… So not exactly fair to say induced by Metamucil.
How do stool softeners like Colace (docusate Na+) or Surfak (docusate Ca++) work?
a) By stimulating intestinal motility
b) By increasing stool bulk
c) By reducing stool surface tension
d) By inhibiting water absorption in the colon
c) By reducing stool surface tension
… which then increases fluid penetration into the stool.
What is the reported onset of action for stool softeners like docusate sodium and docusate calcium?
a) 1-2 hours
b) 6-12 hours
c) 12-72 hours
d) 3-5 days
c) 12-72 hours
(but for some people, can take up to 5 days - just like bulk-forming agents)
Stool softeners like docusate are primarily used as ______ treatment for constipation.
a) Acute relief
b) Prevention
Need to know this
b) Prevention
Which OTC product is a combination of both a stool softener + stimulant?
Senokot-S
(docusate 50mg + sennaside)
Note it has less docusate in this formulation than if were to take Colace capsule on its own.
What is the primary function of lubricating laxatives such as mineral oil?
a) Increase intestinal motility
b) Soften fecal matter
c) Enhance water absorption in the GI tract
d) Reduce inflammation in the gastrointestinal tract
b) Soften fecal matter
Which of the following is a potential complication associated with the use of mineral oil for constipation?
a) Increased absorption of fat-soluble vitamins
b) Improved stool consistency
c) Risk of anal seepage
d) Prevention of lipid pneumonia
c) Risk of anal seepage
When mineral oil is ingested orally as a laxative, it forms a slick layer along the walls of the gastrointestinal tract, including the rectum. This lubrication is intended to facilitate the passage of stool through the intestines.
However, excessive lubrication from mineral oil can result in stool that is overly slippery and difficult to control, increasing the risk of leakage or seepage of stool from the anus
When is the onset of action of mineral oil when taken orally?
a) 1-2 hours
b) 3-4 hours
c) 6-8 hours
d) 10-12 hours
e) 12-72 hours
c) 6-8 hours is the Onset of Action when taken orally.
How many grams of fibre does 1 cup of pitted, uncooked prunes have?
12 grams of fibre
(in every cup of pitted, uncooked prunes)
List the two types of osmotic laxatives.
1) Saline Osmotic Laxative
2) Non-Saline Osmotic Laxative
What do both types of osmotic laxatives [saline and non-saline] generally have in common?
Both osmotic laxatives work by drawing water into the intestines to soften stool and promote bowel movements while increasing stool frequency.
However, they differ in their chemical composition, mechanism of action, onset of action, and other pharmacological properties.
All forms of Osmotic Laxatives (saline and non-saline) are linked to electrolyte imbalances within the colonic lumen and can result in ______kalemia, as well as salt & fluid overload, as well as diarrhea.
HYPOkalemia
It is more common to use Milk of Magnesia as an osmotic saline laxative…
If I am constipated and wanted to use this product for overnight relief, what is the dosage (in mLs) needed to achieve laxative effects?
NEED TO KNOW THE DOSES
Laxative Dose of Milk of Magnesia:
30 to 60 mLs HS
Although it is not a common indication of use, we can technically use Milk of Magnesia as an Antacid…
What is the common dosage (in mLs) and frequency needed to achieve antacid effects?
Need to know these doses
Antacid Dose of Milk of Magnesia:
5 to 15 mLs QID
What are the common adverse effects or side effects when using Glycerin suppositories?
Rectal Irritation is the only adverse effect noted for Glycerin suppositories (for both children and adults).
Regardless of the age of use, the onset of action of Glycerin suppositories is ______
Within 30 minutes!
Polyethylene glycol 3350 (PEG 3350) is used as preventative therapy for constipation.
How long does it take to work (onset of action)?
It can take a few days for sure!
CPS (2023) says 24-96 hours is onset of action
If a patient was told by their MD to try using PEG 3350 to help prevent constipation but not given any other information on how to start… What would you advise this patient?
Start with 1 capful (17 grams) once daily, then titrate Q 2-3 days as required (until get mushy stool consistency)…
Milk of Magnesia, Fleet Enemas, Magnesium Citrate, and Sodium phosphate are all examples of ______.
FYI: Lactulose in this figure but not part of this category of laxative being referred in this question
SALINE Osmotic Laxatives.
FYI: Lactulose is a non-saline osmotic laxative
Dulcolax (bisacodyl), Senokot (senna or sennoside), and Ex-Lax (sennosides or senna) are all examples of Stimulant laxatives…
How do they generally work?
Stimulates the nerves in your colon to force a bowel movement.
What kind of formualtion(s) can people get Dulcolax (bisacodyl) in?
Oral AND Rectal forms
- Oral: EC Tablets, Chews (kids and adults) {+ Dulcolax Canada website also mentions there’s a liquid form, too?)
- Rectal: Suppositories
Ron is a 60-year-old gentleman who comes to the pharmacy asking for your help finding the products he needs for his upcoming colonoscopy prep… One of the items on the list is oral tablets of Dulcolax (bisacodyl) 15mg. When you look on the shelf, you notice we are sold out of all Dulcolax tabs except for the Dulcolax Women.
What is the difference between the two Dulcolax regular vs women?
NOTHING!!!
Dulcolax tablets in the green packaging is the SAME THING (active ingredient is the same) as the Dulcolax Women in pink box.
Dulcolax (bisacodyl) tablets are commercially available in Canada in what strength(s) as OTC?
a) 5mg
b) 10mg
c) 20mg
d) both a and b
e) None of the above
a) 5mg
As of 2024, Dulcolax OTC tablets are only available to purchase as 5mg.
***NOTE: If patients come to the pharmacy and need Dulcolax for colon prep, make sure to read dosing carefully and ensure counsel patient properly on how many tablets to take **
T/F: All Dulcolax products available as OTC (tablets, chews, liquid, suppositories) all have the same ranges in Onsets of Action.
False!!
Dulcolax products available in Canada as OTCs have different Onsets of Action depending on which product and formulation you get.
- EC Tablets: 6-12 hours (overnight relief)
vs.
- Suppositories: 15-60 minutes (acute treatment or relief)
What is the difference between Senokot vs. Senokot-S?
Senokot only contains Sennoside [stimulant laxative].
Senokot-S is a combo product with both Sennoside [stimulant] and docusate sodium [stool softener].
What is the difference in senna content between Senokot regular and Senokot Extra Strength tablets?
A) Senokot regular contains 8.6 mg of senna, while Senokot Extra Strength contains 17.2 mg.
B) Senokot regular contains 8.6 mg of senna, while Senokot Extra Strength contains 11.2 mg.
C) Both Senokot regular and Senokot Extra Strength contain the same amount of senna but possesses different stool softeners in them.
D) Senokot regular needs to be taken BID, whereas Senokot Extra Strength is just taken at bedtime
A) Senokot regular contains 8.6 mg of senna, while Senokot Extra Strength contains 17.2 mg.
What is the recommended adult dosing for Senokot regular tablets?
A) 1-2 tablets once or twice daily, preferrably at bedtime
B) 2-4 tablets once or twice daily, preferably at bedtime
C) 1-2 tablets once or twice daily in the morning and bedtime
D) 2-4 tablets once or twice daily in the morning and at suppertime
B) 2-4 tablets once or twice daily, preferably at bedtime
Which of the following accurately distinguishes between Senokot and Senokot-S?
A) Senokot-S contains an additional active ingredient compared to Senokot.
B) Senokot-S is formulated specifically for pediatric use, whereas Senokot is for adults only.
C) Senokot-S is a stimulant laxative containing docusate sodium, while Senokot is solely a stimulant laxative.
D) Senokot is available over-the-counter, while Senokot-S requires a prescription from a healthcare professional.
C) Senokot-S is a stimulant laxative containing docusate sodium, while Senokot is solely a stimulant laxative.
Ex-Lax is another form of which kind of laxative?
- Please identify both the drug class as well as the active ingredient(s).
Drug Class: Stimulant Laxative
Chemical: Sennosides (or Senna)
Tommy is a 22-year-old uni student who has been stressed about final exams and has not had a bowel movement in 3 days and feels blocked as a result. He is currently staying with his older sister, her husband, and their 2-year-old toddler.
He wants to try Ex-Lax Chocolate pieces as he doesn’t like to take pills. What is something is worth mentioning during counselling?
a) Confirm he does not suffer from any electrolyte imbalances, kidney dysfunctions, or take anything like diuretics or potassium as the ingredients can make things worse for electrolytes.
b) Advise patient that this can cause stomach upset and cramping and might want to consider an alternative depending on what he means when he says he feels “blocked”
c) Do not have the medication within reach of the toddler as this can be dangerous.
d) Both a and c
e) Both b and c
f) All of the above
f) All of the above!!
- Ex-Lax contains different minerals and ingredients like potassium and calcium. This product can increase electrolyte imbalances especially if already taking things like diuretics which can already increase potassium levels and such.
- Although senna is a more mild stimulant, if a person is already experiencing upset stomach and such, this can make it worse and uncomfortable and is not always recommended if that is the case.
- Need to be cautious if something like a chocolate medicine is nearby children as they might mistake this as sweets. Taking 2 pieces is already too high of a dose than what is typically recommended for a 2-5 year age group child.
T/F: The adult dosing for Senokot Extra Strength tablets is lower than that of Senokot regular tablets.
MAKE SURE to understand the differences
False.
If you do the math, it is relatively the same…
Senokot (regular) has 8.6mg per tablet and indicative to take 2-4 tabs [17.2-34.4mg] OD-BID, preferably at HS….
- Daily intake (regular) would range from 17.2mg to 68.8mg/day
Senokot XS has 17.2mg per tablet and indicates to take 1-2 tabs [17.2-34.4mg] OD-BID, preferably at HS… =
- Daily intake (XS) would range from 17.2mg to 68.8mg/day
