GI - constipation, diarrhoea, IBS, and haemorrhoids Flashcards
I think I’m suffering from constipation, I’m going to the toilet less. Am I right?
Yes, constipation is a reduction in your usual bowel habits which vary for everyone
What kind of symptoms are you experiencing?
Straining Lumpy or hard stools Emptying bowels less Bloating/abdominal discomfort Not feeling emptied Nausea
I’m just going to ask a few questions to try and establish the cause.
What is your diet like at the moment? Lack if fibre can cause
Do you drink water everyday? Fluids help bowel movement
Do you take any regular medication?
Have you been pregnant or given birth recently?
Have you changed your diet recently? Diet changes
Do you exercise regularly? Movement can help
Do you suffer from anxiety/depression/stress?
Do you ever ignore the urge to go or not have the chance to go when you need to?
When should you refer?
Is there any blood in the stools?
How long has this been going on? 14 days
Are you in any pain? Could you rank the pain for me?
Is this a sudden change?
Are you feeling tired or fatigued alongside these symptoms?
A laxative might be a good option for you.
Bulk forming laxatives increase the mass of faecal matter by retaining fluid (FYBOGEL)
- takes several days
- do not take just before bed
- take with plenty of water to avoid obstructions
Faecal softeners soften stools for easier passing (DULCOEASE)
Osmotic laxatives stimulate movement (peristalsis) in the bowel (LACTULOSE)
- takes 1-2 days
Stimulant laxatives stimulate colonic and rectal nerves (SENNA)
- takes 8-12hrs
- take in evening
What advice can you give?
Increase your fluid intake More fibre More exercise Reduce caffeine intake Do not delay the urge to go Rest feet on low stool when going and raise knees above hips
Key questions to ask for diarrhoea
What are your symptoms? watery stools, cramps, flatulence
How long have you had them for? Refer if chronic
Could you have eaten any undercooked food? Bacterial
Could you have a viral infection? Norovirus
Are you under any stress? Could cause
Is there any blood or mucous in the stools? Refer
What time of day is this happening? Could be IBS if first thing in morning or at night
Have you been abroad recently? Refer
Are you taking antibiotics? Refer
Are you pregnant? Refer
What treatments are there?
- Anti-motility agents
e. g. loperamide (for over 12s) - Oral rehydration sachets
e. g. dioralyte - Increase fluids to keep hydrated
- Rest as much as you can
- Eat when you are able to
- Paracetamol for discomfort
- Avoid fruit juice and fizzy drinks
Symptoms of IBS
Abdominal pain and discomfort Pain relieved by defecation and passing wind Altered defecation Changes in stool form Bloating Diarrhoea or constipation Lethargic No control over pooing
Treatments
Hyoscine butylbromide (Buscopan) Loperamide Salts Reduce stress Keep food diary Probiotics Reduce alcohol and fizzy drink consumption Exercise Eat meals regularly Making meals from scratch to control what is in them Avoid foods that are hard to digest
I am experiencing bleeding from my bottom. Can you offer anything for this?
Are you experiencing any other symptoms? Haemorrhoids: itching, mucous, pain on defection, not feeling emptied, lumps around anus
Is the blood mixed with your stool or just around bottom? Refer if mixed with stool
What colour is the blood? Should be light for haemorrhoids
Have you had any changes in bowel movement? Yes and over 40 - refer
Are you having severe pain when defecating? Yes - refer
What is your diet like? Need more fibre
Are you finding yourself straining to go?
Are you heavy lifting recently e.g. for your job?
How often are you eating full meals?
Do you take any medication?
Do you have any allergies?
Do you have any other conditions? Chronic cough
Okay great. What treatment do you recommend?
- You can take painkillers to reduce the pain if that is a problem, e.g. ibuprofen can reduce inflammation
- Anti inflammatory creams to reduce soreness, e.g. hydrocortisone, 1 week maximum use
- Astringents, e.g. anusol
- Try not to strain or spend too long on the toilet
- Barrier creams like sudocrem can protect any bleeding cuts
- Increase your fibre and fluid intake to improve ease of moving faeces
- Warm baths
- Use baby wipes to clean the area as this will soothe it as well
