Palliative Care: Constipation Flashcards
What is constipation?
Hard faeces
Uncomfortable or difficult to pass
Reduced frequency compared with normal pattern
What symptoms or signs are associated?
Sense of incomplete evacuation after defecation Leakage of faecal fluid (faecal incontinence) Colicky abdominal pain Abdominal distension Flatulence Nausea and vomiting Anorexia Malaise Headache Halitosis Urinary frequency and retention
What can cause constipation?
Disease related: immobility, reduced food intake, abdominal and pelvic disease
Fluid depletion: poor intake, increased loss- vomiting, sweating, fistula, wounds
Weakness: inability to raise intra abdominal pressure
Obstruction: adhesions, recent surgery, mass
Biochemical: hypercalcaemia, hypokalaemia, hypothyroidism
Other: pain on defecation, diverticulitis
What medications can cause constipation?
Opioids Diuretics Anticholinergics 5HT antagonists Iron supplements
What classes of laxatives are there?
Stimulant Softener (bulking) Osmotic Suppositories Lubricant
How do osmotic laxatives work?
Increase the amount of fluid in the bowel, thereby softening the stool
What examples of osmotic laxatives are there?
Lactulose (for people generally well)
Movicol
Laxido
How do stimulant laxatives work?
Stimulate bowel to contract
Reduce bowel transit time
What examples of stimulants are there?
Sodium picosulphate
Senna
Bisacodyl
How do softeners work (bulk forming)?
Increase water penetration of stool
What examples of softeners are there?
Docusate Ispaghula husk (fybogel)
What types of suppositories are there?
Glycerin - softener
Phosphate - stimulant
Bisacodyl
What laxative is typically tried first?
Softener (bulk forming)
