Laxatives

Question 2

Management chronic constipation

Answer 2

Counselling 1. advice on lifestyle measures
increasing dietary fibre
ensuring adequate fluid intake
ensuring adequate activity levels

Pharmacological
first-line laxative: bulk-forming laxative first-line, such as ispaghula
second-line: osmotic laxative, such as a macrogol
Stimulant laxative eg senna

if frail, consider softner first

Question 3

when should you stop taking laxatives?

Answer 3

Advise the person to gradually reduce and stop laxatives once the person is producing soft, formed stool without straining at least three times per week.

Question 4

Management opiod induced constipation

Answer 4

1. Osmotic laxative eg lactulose PLUS stimulant laxative eg senna

Question 5

Management acute constipation eg recent illness, immobility etc

Answer 5

1. Senna (stimulant)

Question 6

Management ibs constipation

Answer 6

1. Docusate (softener)

Question 7

what laxative should you avoid ibs

Answer 7

lactulose

Question 8

what laxatives should you avoid opioid induced

Answer 8

Do not prescribe bulk-forming laxatives.

Question 9

specialist management of refractory constipation

Answer 9

prucalopride (specialist prescribed)

consider if at least two laxatives from different classes have been tried at the highest tolerated recommended doses for at least 6 months, and failed to relieve symptoms, where invasive treatment (such as suppositories, enemas, rectal irrigation and/or manual disimpaction) is being considered.

Question 10

name a bulk forming laxative

Answer 10

ispaghula husk

Question 11

name a softner laxative

Answer 11

docusate

Question 12

name 2 stimulant laxative

Answer 12

senna
bisacondyl

Question 13

name 2 osmotic laxative

Answer 13

macrogol
lactulose

Question 14

when to not prescribe bulk forming

Answer 14

flatulence and bloating. Excessive doses or inadequate fluid intake may cause intestinal obstruction.

Question 15

consideration macrogol

Answer 15

Macrogol laxatives can cause medications taken one hour before, during and one hour after to be flushed out of the gastrointestinal tract unabsorbed which includes contraceptive pills.

Question 16

should you use two laxatives at the same time

Answer 16

NOT of same class

YES of different classes (synergistic

Question 17

what to consider if diarrhoea on laxatives

Answer 17

impaction and overlfow

Question 18

second line chronic constipation (after bulk forming)

Answer 18

add macrogol

Question 19

Management faecal loading

Answer 19

1. Macrogol (osmotic)
2. Add oral stimulant eg senna
3. Enema or suppository
   A suppository such as bisacodyl for soft stools; glycerol alone, or glycerol plus bisacodyl for hard stools.
   A mini enema such as docusate (softener and weak stimulant) or sodium citrate (osmotic).