Constipation Flashcards
What is the definition of constipation?
Onset >6months pre-diagnosis, must include 2 symptoms at 25% of defecation
Straining
Lumpy/hard stools
Sensation of incomplete evacuation
Sensation of anorectal obstruction/blockage
<3 movements/week
Manual maneuvers to facilitate defecations
Loose stools are rare
Discomfort, NOT pain
What is primary vs secondary constipation?
Primary: idiopathic, or loinked to GI motor disorders.
Secondary: disease or medication linked
What are red flags for constipation?
Unintended weight loss >10lbs
Onset of symptoms >50
Family history of colorectal cancer or IBD
Nausea, vomiting, abdominal pain, fever or melena
What are non-pharm methods of preventing constipation?
- Adequate fluid intake (1.5L/day)
- Fibre
- Bowel retraining (don’t hold it in)
- Exercise
- Manual manipulation
- Probiotics
What is the recommended daily fibre intake for an adult male/female?
Female: 25g
Male: 38g
What type of fibre is good for constipation?
Soluble fibre– will slow down digestion and relieve constipation
How do bulk forming laxatives work?
Increased biomass, osmotic load, water retention and wall stress stimulating motility
Good for preventing
Imperative for patients to drink a lot of water with these laxatives
What are contraindications for bulk forming laxatives?
Gastric obstruction, fecal impaction, anyone with swallowing difficulties
How do osmotic agents work to treat constipation?
Acidifies intestinal fluid and creates a gradient so that water is drawn into the lumen. Strong evidence that it increases stool consistency and frequency
Ex. PEG (1st line for kids), sorbitol 50%, lactulose, glycerin suppository (fast acting)
How do stool softeners work?
Act as surfactants, soften the stool by allowing the mixing of aqueous and fatty substances
No RCTs to prove efficacy– not much better than placebo, and don’t have much place in therapy.
Should be avoided and not recommended
How do saline laxatives work?
Create an osmotic gradient and draw fluids into the intestinal lumen. Magnesium, or sodium phosphate.
Works within a day-2 days, but not recommended to give to someone with CHF, renal failure or elderly because of the electrolyte disturbances.
What are downsides of enema usage?
Dependence, electrolyte imbalance, rectal damage. Should only be used pre-test, or when prescribed.
How do stimulant laxatives work?
Produce contractions in intestines to propel gut contents
Fast onset of action– overnight
Recommended for opioid users to prevent opioid induced constipation
Concerns with dependence, but limit when possible
What evidence exists to support the use of herbal treatments?
No RCTs to support their use
