Constipation Flashcards
what are the 4 types of laxatives and their action?
osmotic - draw water into the colon to allow easier passage of stool
bulker - absorbs water to form soft bulky stool promoting normal contraction
softener - decreases surface tension and increases penetration of intestinal fluid to stool
stimulants - trigger rhythmic contraction of the intestinal muscles
side effects of osmotic laxatives.
bloating abdominal cramping diarrhoea flatulence increased thirst nausea
side effects of stimulant laxatives.
abdominal cramping bloating diarrhoea nausea urine discolouration with senna
side effects of bulkers.
bloating
flatulence
constipation if not taken its enough water
side effects of softeners.
electrolyte imbalance with prolonged use
what electrolyte abnormalities can laxative abuse cause?
hypokalaemic, hypochloraemic metabolic alkalosis
what is first line treatment for short term constipation?
bulker laxative e.g. Isphagula
what is first time treatment for opioid induced constipation?
osmotic laxative e.g. lactulose + stimulant e.g. senna
bulkers are avoided in opioid induced constipation.
describe the treatment of chronic constipation.
1st line - bulker
2nd line - add or switch to osmotic
3rd line - add stimulant
describe the treatment of short term constipation.
1st line - bulker
2nd line - add or switch to osmotic
3rd line - add stimulant
describe the treatment of opioid induced constipation.
1st line - osmotic + stimulant
2nd line - naloxegol
3rd line - methynaltrexone bromide
what is first line treatment of constipation in pregnancy and breast feeding?
bulker laxative (1st line in breast feeding too)
are laxative safe during pregnancy and breast feeding?
yes
stimulants should be avoided near term and if history of unstable pregnancy
stimulants should only be taken under advice from specialist during breast feeding
what are complications of constipation?
faecal impaction
overflow diarrhoea
haemorrhoids
acute urinary retention
describe the treatment of faecal impaction.
if hard stool
- high dose oral macrogel (i.e. macrogel 3350 with KCl)
if soft stool (or hard stool few days after macrogel)
- oral stimulant laxative
