GI Therapeutics Flashcards
Constipation
Condition of unsatisfactory defection through passing stools less frequently than normal, difficult passing stools or the feeling of incomplete emptying when opening the bowel
What is the Rome IV diagnostic criteria classify constipation as
Spontaneous bowel movements occurring fewer than 3 times per week
Constipation is classed as, if it lasts < 3 months
Short term
What age group affect constipation
Which gender is more likely to have constipation
- affects all age group, more common in those over 60 years old
- 2-3 more common in women than men -> common in pregnancy
How is constipation diagnosed
Through questioning the patient about frequency and consistency of stool passed
What are the risk factors for constipation
- sedentary lifestyle
- poor diet (low fibre and fluid intake)
- avoiding going to the toilet when needed = suppress the reflex
Can constipation be drug-induced
Yes
Particularly by opioid analgesics = so need to prescribe lactose beside it
What are the symptoms of constipation
- weight loss
- blood in stool
- painful when passing stools
- change in appetite
- sudden change in bowel habits
- abdominal pain
- associated fever, nausea/vomitting
- suspected laxative abuse
- constipation in children
Management of constipation
= with laxatives - dependent on cause, patient’s age, time to effect required and level of fibre and fluid intake
- laxatives that are OTC
- prucalopride (5HT4-receptor agonist) available on prescription
= advice to increase physical activity sans fluid intake to help prevent further constipation
= eat a balanced, healthy diet : try to maintain regular eating pattern
= advice to maintain regular toilet routine to allow sufficient time for complete emptying of bowl and to answer the call of nature when needed rather than holding it
= minimise complications of constipation
Examples of constipation
- bulk forming e.g. ispaghula side effect: get bloated. Obtain water
- osmotic e.g. lactulose or macrogols = this and above take 12-24 hr period for affect to appear
- surface-wetting agents e.g. docusate: make surface more smoother
- stimulant e.g. senna, sodium picosulfate, bisacodyl; best time to take this is at night - can go to toilet in the morning as it takes around 12 hrs
- enemas and suppositories - phosphate enemas, glycerol suppositories
