CONSTIPATION

Question 1

CONSTIPATION:
Definition?

Answer 1

Reduced frequency of pooping compared to what is normal for that person often accompanied by straining and the passage of small, hard stools. Common in pregnancy and mainly women

Question 2

CONSTIPATION:
when should patients be referred?

Answer 2

New or worsening constipation without adequate explanation, blood in stools(unless haemorrhoids are suspected), weight loss, nausea and vomiting.

rectal bleeding unrelated to bowel motion-A and E

Urgent GP referral:
Malaena- black/tarry stool
bloody stools with clots
high fever and shivering
worsening pain in rectal area
swelling
abdominal pain w/ fever

Question 3

CONSTIPATION:

What are differential diagnoses?
What are treatment options?

Answer 3

intestinal obstruction, faecal impaction, colicky pain

b) Lifestyle measures

Drug treatment- if drug induced constipation or if lifestyle not helped. 

If drug induced should get regular prescribing

BNF suggests laxative be avoided except where straining will exacerbate a condition such as angina or increase the risk of rectal bleeding as in haemorrhoids.

Question 4

CONSTIPATION:

What are the FIVE types of laxatives and how do they work?

Answer 4

Bulk-forming: Retaining water in the gut and increasing faecal mass, therefore stimulating peristalsis. Delayed onset so not appropriate for acute or occasional relief.

Side effects: bloating, distension, flatulence

Osmotic: act by increasing the absorption of water into the large bowel. Takes 48 hours to be effective.

Stimulant: Stimulating the colonic nerves to increase intestinal motility. Work in 8 to 12hours. should be taken at night. Frequent use can lead to fluid and electrolyte imbalance.

Stool softener: Reducing surface tension and increasing penetration of intestinal fluids into the faeces.

Glycerol: dual action they are stool softeners and stimulants and used for rapid relief -30mins. Liquid paraffin is stool softener but not recommended due to anal seepage.

Question 5

CONSTIPATION:

Give examples of all FIVE types of laxatives

Answer 5

Bulk-forming: isphagula husk
Osmotic: lactulose
stimulant- Senna and bisacodyl
stool softer: docusate sodium
dual action-stool softener and stimulant: docusate
glycerol

Question 6

CONSTIPATION in children:
What are symptoms?
When do you refer?
What are treatment options?

Answer 6

Most common in boys aged 2-4
tummy ache, pain when attempting to pass stool, getting upset or anxious about going toilet.

Refer if: child feels weak,dizzy, has marked anal pain or defecation or blood in stools

Lifestyle advice; drinking enough fluids, prune juice, juices containing sorbitol

Question 7

CONSTIPATION in pregnancy:
Which is safest laxative in pregnancy?

Answer 7

Bulk forming and osmotic laxatives as they are not absorbed.

Stimulants should be avoided in third trimester as it may cause uterine contractions

Senna enters east milk so may cause colic and diarrhoea in infant

Question 8

CONSTIPATION:
What is laxative dependence and what can it lead to?

Answer 8

prolonged laxative use leads to degeneration myenteric plexus of colon.
Increasing doses of laxatives have to be ingested to obtain a response.
risk include hypokalaemia