Constipation Flashcards
(29 cards)
How long must symptoms persist to be considered chronic constipation?
At least 3 months.
Name three red flags associated with constipation.
New-onset in >50s, unexplained weight loss, anaemia, blood in stool.
What are potential risks of laxative abuse?
Hypokalaemia, dependency.
What lifestyle measures are first-line in all patients with constipation?
Increase fibre gradually, ensure hydration, and encourage physical activity.
May take up to 4 weeks for a high fibre diet to have effects.
Name two bulk-forming laxatives.
Ispaghula husk, methylcellulose.
What is a key patient advice when using bulk-forming laxatives?
Drink plenty of fluids to prevent obstruction.
How do stimulant laxatives work?
Increase gut motility by stimulating the bowel wall.
Which stimulant laxatives belong to the anthraquinone group?
Senna, co-danthramer, co-danthrusate.
When are co-danthramer and co-danthrusate used?
In terminally ill patients only due to carcinogenic risk.
How do faecal softeners work?
Reduce surface tension, allowing water to penetrate stool.
Give an example of a faecal softener with dual action.
Docusate sodium (softener + stimulant).
How do osmotic laxatives work?
Draw water into the bowel or retain fluid, softening stool.
Why is lactulose useful in hepatic encephalopathy?
Lowers pH and reduces ammonia-producing bacteria.
What is prucalopride and when is it used?
A 5HT4 agonist for chronic constipation unresponsive to other laxatives (used in women).
Which agent is specifically used for IBS with constipation?
Linaclotide.
What should be avoided in opioid-induced constipation?
Bulk-forming laxatives.
What is first-line treatment for opioid-induced constipation?
Osmotic laxative ± stimulant laxative.
Name one drug for resistant opioid-induced constipation.
Naloxegol or methylnaltrexone.
Are bowel cleansers (e.g. moviprep) used to treat constipation?
No – they are used to prepare the bowel before procedures.
What is the stepwise approach in short-term constipation?
Start with bulk-forming → osmotic if hard stools → stimulant if still difficult.
What is first-line for chronic constipation?
Bulk-forming laxative.
When can prucalopride be considered?
If 2+ laxatives fail at max dose for ≥6 months (women only).
What’s first-line for hard faecal impaction?
High-dose oral macrogol.
Same in macrogol.
What if stools are soft but impaction persists?
Add stimulant or use rectal options like bisacodyl or glycerol.
