Constipation (4.5)

Question 1

What are some properties of constipation?

Answer 1

• Very common
• Often self-diagnosed by patient
• Normal bowel habits –> 3 motions per day to 3 per week

Only an issue if there

>Change from ones normal: reduced frequency, hard stools and/more difficult defecation

Question 2

For constipation;

A) who is the patient

B) What are the symptoms

C) How long

D) Action taken

E) Medications?

F) Medical conditions

G) Allergies (N/A)

H) Extended questions

Answer 2

A)

• Age: elderly and children
• Gender
• Pregnant or breastfeeding

B)

• Details of current bowel habit –> usual bowel habit
• Pain
• Blood
• Diet and lifestyle

C)

• Persisting change (> 2 weeks-adults and 1 week-child)
• Sudden onset

D)

• Laxative use

E)

• Constipating medications

F)

• Depression, hypothyroidism, parkinsons disease

G)

N/A

H)

• Change of diet our routine?
• Pain on defecation?
• Presence of blood
• Duration (chronic or recent)
• Lifestyle changes?

Question 3

What are some medications which cause constipation?

Answer 3

See attached image

> Antacids
> Supplements

>Antichlolinergics

>Antihypertensives

>Opioids

Question 4

When to refer for constipation?

Answer 4

• Blood/mucuous in stool
• >14 days duration with no identifiable cause (for child >7days)
• Pain on defecation
• > 40 years of age (with sudden change in bowel habits)
• Sudden change in bowel habits without obvious cause
• Suspected depression or hypothryoidism
• Vomiting
• Unintentional weight loss
• Tenesmus (continuous feeling of needing to defacate)
• Family history of inflammatory bowel disease (IBD) or colon cancer

Question 5

What are some non-pharmacological managements for constipation?

Answer 5

• Diet - 2 fruits and 5 vegetables daily
• Exercise
• Fluid intake 2L/day
• Behavioral modification

> FIrst step: assess diet and lifestyle

> Ensure adequate intake of fluid (2L/day)
>Ensure adequate intake of dietary fibre (with sufficient fluid)

• 25g to 30g of fibre daily in adults
• Fibre intake should be increased slowly to avoid flatulence and bloating

> Increase exercise and remain active

> Toileting after meals as maximal gastrocolic reflex

• Maintain good toilet position
• Toilet stool (35-degree angle), use a stool

Question 6

For constipation, what is the management options based on?

Answer 6

• Symptoms
• Required onset of action
• Patient preference
• Adverse effects
• Effectiveness of previous treatments
• Cost
• Patient characteristics: BF: all safe

> Pregnancy: avoid stimulant laxatives

> Pregnancy: docusate, lactulose and sorbitol are safe