Post-OP Constipation Flashcards
Definition of post-op constipation.
Infrequent bowel movement <3 a week
Often with hard, dry stools that may be painful and difficult to pass
Main causes of constipation on surgical ward
Physiological (low fibre diet, poor fluid intake, low physical activity)
Iatrogenic - Medications like opioid analgesia, anticonvulsants, iron supp or antihistamines.
Pathological - Bowel obstruction, hypercalcaemia, hypothyroidism or neuromuscular disease.
Functional like painful defecation
Clinical features
Lower abdo pain
Can have abdominal distension, N+V or decreased appetite.
Usually no clinical signs on examination
DRE is essential for any patient with constpiation
Investigations
Usually a clinical diagnosis
If no cause can be identified do routine bloods + TFTs or serum Ca2+.
Abdo X-ray, CT scans or endoscopies are generally not indicated unless obstruction is suspected.
Conservative management
Adequate hydration
Sufficient dietary fibre
Pharmacological treatment
Osmotics
Stimulants
Bulk forming laxatives
Rectal medications
Explain osmotic laxatives
Increase the amount of fluid in the bowel and softens stool
Lactulose and movicol
Explain stimulant laxatives
Causes the bowel to contract and expels faeces.
Like Senna and Picosulphate
Explain bulk forming laxatives
Help stool to retain water therby softening stool
Isphaghula husk
Rectal medications
Glycerin suppository (stimulant)
Phosphate enema (stimulant)
When should stool-softening laxative be given?
In patients with hard stool and chronic constipation
When should stimulant laxatives be given?
Post-OP ileus
Opioid-induced constipation
Soft stool
What can be done if pharma dont work?
Manual evacuation or an enema
Prophylaxis
Opioid-sparing analgesia
Prophylactic stimulant laxative like Senna
