Faecal Incontinence + Constipation Flashcards

1
Q

Most common cause of faecal incontinence

A

Faecal impaction with overflow diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of faecal incontinence

A
  • faecal impaction with overflow diarrhoea (most common)
  • neurogenic dysfunction e.g MS, post stroke, spinal cord ingury
  • rectal prolapse
  • damage to anal sphincter muscles (often from childbirth or surgery)
  • haemorrhoids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is faecal incontinence?

A

Inability to control bowel movements > involuntary leakage of stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is involved in assessment of faecal incontinence?

A
  • per rectum assessment
  • rectum + prostate exam
  • anal tone
  • sensation
  • visual inspection
  • stool sample if in rectum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment of faecal incontinence

A
  • increasing fibre intake e
  • reduce caffeine + alcohol
  • pelvic floor exercises
  • anti-diarrhoeal drugs / laxatives depending on cause
  • bowel management programs: regular use of enemas or suppositories
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is faecal loading?

A

Accumulation of a large amount of hardened stool in the rectum or colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is faecal impaction?

A

Severe case of faecal loading where a large, hard mass of stool becomes stuck in the rectum or colon, obstructing normal bowel movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complications of faecal impaction + constipation

A
  • stercoral perforation
  • ischaemic bowel
  • urinary retention
  • rectal damage/anal fissures (due to straining)
  • falls risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is stercoral perforation?

A

Life threatening condition where a hole forms in the wall of the colon or rectum due to pressure from impacted stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is constipation?

A

Difficulty in passing stools (strainnig), infrequent bowel movements (<3 per week), passing hard/dry stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of constipation/faecal impaction

A
  • enemas for rectal loading
  • stool softeners e.g. liquid paraffin, docusate sodium
  • stimulants e.g. senna
  • osmotic laxatives e.g. lactose, macrogol
  • manual evacuation (if severe + risk of perforation)
  • increase dietary fibre + fluid intake
  • toilet routine + positioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

examples of faecal softeners

A

liquid paraffin
docusate sodium
arachis oil enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examples of osmotic laxatives

A

lactulose
macrogol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Examples of stimulant laxatives

A

senna
bisacodyl
sodium picosulfate
glycerol suppositories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bristol stool chart

A
  • type 1: separate hard lumps (like nuts) that are hard to pass
  • type 2: sausage shaped but lumpy
  • type 3: sausage shaped but with cracks
  • type 4: sausage shaped but smooth + soft
  • type 5: soft blobs with clear cut edges
  • type 6: fluffy pieces with ragged edges
  • type 7: watery, no solid pieces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do the types indicate in the Bristol stool chart?

A
  • type 1-2: constipation
  • type 3-4: ideal stools
  • type 5-7: diarrhoea + urgency
17
Q

What can cause diarrhoea?

A
  • drugs e.g. domperidone, metoclopramide
  • infection e.g. cholera, salmonella
  • toxins
  • radiotherapy
  • anxiety
18
Q

What should be done in a person with chronic diarrhoea?

A
  • exclude all underlying causes by bowel imaging + stool culture
  • remove all potentially causative medications
  • exclude faecal impaction
  • investigate red flag symptoms e.g. weight loss, blood, new change in bowel habit
  • dietary review
19
Q

Treatment of diarrhoea

A
  • treat the cause (if one)
  • treat any complications e.g. oral rehydration/IV fluids
  • opioids e.g. codeine, loperamide
  • antimuscarinics
20
Q

How do opioids work in treatment of diarrhoea?

A

acts of u + delta receptors to slow movement in GI tract by reducing muscular contractions > allows more time for water absorption

21
Q

How does loperamide work in treatment of diarrhoea?

A
  • specific to u receptors in myenteric plexus
  • decreases tone of longitudinal + circular muscle
  • reduces peristaltic but increases segmental contractions
  • decreases colonic mass movement by suppressing gastrocolic reflex
22
Q

Pharmacological treatment of chronic diarrhoea in older people

A

loperamide
.
Avoid opioids

23
Q

What needs to be considered before giving arachis oil?

A

It is made of peanut oil
Peanut allergies