Constipation Flashcards
(44 cards)
What basic questions should be asked when assessing a patient with constipation?
Ask about:
- Last bowel movement
- Patient’s baseline bowel habit
- Abdominal symptoms (pain, distension, nausea, vomiting)
- Flatus passage
- Symptoms suggestive of obstruction
What physical exam components are important in a patient with constipation?
Include:
- General observation (e.g., discomfort, bloating)
- Abdominal examination (tenderness, distension, bowel sounds)
- Rectal examination if concerned for impaction or obstruction
Which medications are commonly associated with causing constipation in hospitalized patients?
Medications include:
- Opioids
- Anticholinergics (e.g., amitriptyline)
- Iron supplements
- Calcium supplements
- Verapamil
- Antipsychotics
When is abdominal imaging indicated in the workup of constipation?
Consider imaging when:
- Obstruction is suspected
- There is severe or worsening abdominal pain
- No bowel movement or flatus for days
- Physical exam suggests possible impaction or volvulus
List common types of laxatives and their mechanisms.
- Osmotic: Lactulose, PEG – draw water into bowel
- Stimulant: Senna, Bisacodyl – increase peristalsis
- Stool softener: Docusate – reduce stool surface tension
- Suppository: Bisacodyl or glycerin – local stimulation
- Enema: Phosphate or mineral oil – stimulate evacuation
How should constipation be managed if the patient is also on opioids?
Start scheduled laxatives:
- Use stimulant (senna) + osmotic (PEG)
- Avoid relying on PRN use only
- Consider methylnaltrexone if refractory (specialist input needed)
What should be documented in the medical record for a patient treated for constipation?
Include:
- Time and date of last bowel movement
- Assessment of bowel sounds and abdominal findings
- Laxatives given (type, dose, route)
- Plan for follow-up (monitor for response, reassess)
What non-pharmacological measures can help with constipation?
- Encourage oral hydration
- Mobilize patient as tolerated
- Dietary fiber intake if feasible
- Encourage a routine bathroom schedule
How can you distinguish between simple constipation and ileus or obstruction?
Ileus/obstruction signs:
- No flatus or BM
- Diffuse abdominal pain/distension
- Vomiting, particularly bilious or feculent
- High-pitched or absent bowel sounds
- Imaging showing air-fluid levels or dilated loops
Why is early intervention for constipation important in hospitalized patients?
Because delayed management can lead to complications such as:
- Fecal impaction
- Bowel obstruction
- Delirium (especially in elderly)
- Increased hospital stay
What are the advantages of using a bowel regimen prophylactically in certain patients?
- Prevents constipation before it occurs
- Reduces need for emergency interventions
- Improves patient comfort and satisfaction
- Supports safe opioid administration
What patient populations are at higher risk of constipation?
- Elderly patients
- Patients on opioids or anticholinergics
- Bedbound or immobile patients
- Patients with neurological diseases (e.g., stroke, Parkinson’s)
- Postoperative patients
When should manual disimpaction be considered?
Indicated when:
- Rectal exam confirms hard stool
- Laxatives and enemas have failed
- Patient has symptoms of obstruction with impaction
- There’s urgency to relieve discomfort or risk of worsening symptoms
How can electrolyte imbalances contribute to constipation?
- Hypokalemia impairs colonic smooth muscle contractility
- Hypercalcemia can cause dehydration and reduce GI motility
- Magnesium imbalances may influence neuromuscular function
What is the role of suppositories in managing constipation?
- Deliver medication directly to the rectum
- Stimulate local nerve endings for evacuation
- Useful when oral intake is contraindicated
- Faster onset than oral medications
What is a safe and commonly used osmotic laxative in hospital settings?
- Polyethylene glycol (PEG)
- It draws water into the bowel lumen to soften stool
- Generally well tolerated and effective for most patients
How should PRN laxatives be reviewed during rounds?
- Check how many doses were given in the last 24 hours
- Assess if they were effective in producing a bowel movement
- Escalate treatment if PRN agents were insufficient
What findings might you expect on an abdominal X-ray in constipation?
- Dilated loops of bowel
- Air-fluid levels (suggest obstruction)
- Large stool burden in colon
- No gas in rectum if impaction or complete obstruction
When should you escalate from oral laxatives to enemas?
- No bowel movement after 24–48 hours of oral therapy
- Symptoms are worsening
- Abdominal distension or discomfort increases
- Suspected fecal impaction
What is the role of dietary fiber in managing constipation?
- Increases stool bulk and water content
- Stimulates peristalsis
- Should only be used if no bowel obstruction
- Gradually introduce to avoid bloating
Why should phosphate enemas be used cautiously in elderly patients?
- Risk of electrolyte disturbances
- Can lead to hyperphosphatemia, hypocalcemia, and AKI
- Consider alternative enemas (e.g., mineral oil) in frail patients
How can you tailor a bowel regimen to a patient’s needs?
- Base regimen on cause (e.g., opioid-induced)
- Use stimulant + softener for opioid constipation
- Consider route: oral, suppository, or enema
- Monitor response and adjust daily
What are signs that a patient may be developing fecal impaction?
- No bowel movement for several days
- Leakage of liquid stool (overflow diarrhea)
- Abdominal discomfort or pain
- Palpable stool on rectal exam
What is overflow diarrhea and how is it related to constipation?
- Occurs when liquid stool leaks around an impacted fecal mass
- Often mistaken for infectious diarrhea
- Indicates longstanding constipation or impaction
