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Flashcards in Constipation Deck (21)
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What is NICE CKS definition of constipation ?

less than 3 times a week


What are the red flag symptoms of constipation ?

new-onset constipation in over 50 years
abdominal pain
unexplained weight loss
over or occult blood


What is the 1st line treatment for short-duration constipation ?

Advise on lifestyle measures, such as increasing dietary fibre, fluid intake, and activity levels.
If not effective then bulk forming laxatives ( fybogel, methylcelullose, sterculia)


How does bulk forming laxatives work ?

swells in gut to increase feacal mass to stimulate peristalsis, works within 24 hours but takes 2-3 days ( 72 hours) for full effect.


What are the side effects of bulk forming laxatives ?

bloating, cramping, flatulence, and gut obstruction


How should you counsel patients on bulk forming laxatives ?

drink an adequate fluid intake
take it not immediately before food


What is the handling and storage of isphagula husk ?

contains potent allergens: hypersensitivity reactions


What is the 2nd line treatment for constipation ?

If stools remain hard or difficult to pass, add or switch to an osmotic laxative (lactulose, magnesium hydroxide), such as a macrogol. If a macrogol is ineffective or not tolerated, offer treatment with lactulose second-line.


How does osmotic laxatives work ?

Increases water in colon by drawing fluid from the body or retains fluid administered with.
Lactulose: causes osmotic diarrhoea of low feacal ph.
Macrogols: sequester fluid in bowel.
Osmotics works within 2-3 days. 48 hours for lactulose.


What are the side effects of lactulose ?

discomfort, flatulence, cramps, nausea, when starting lactulose.
Nausea reduced by administering with water, fruit juice or meals.


What is the third line treatment for constipation ?

If stools are soft but difficult to pass, or there is a sensation of inadequate emptying, add a stimulant laxative (bisacodyl, sodium picosulfate, Senna, glycerol, docusate sodium)


How does stimulant laxatives work ?

increases intestinal motility by irritating gut lining
glycerol suppositories work in about 15-30 min
works within 6-12 hours


What are the side effects of stimulant laxatives ?

abdominal cramps
Senna colours urine yellow-brown
excessive use: hypokalaemia, diarrhoea, lazy bowel


What are the other laxatives that are only used in palliative patients and why they only reserved for palliative care ?

co-danthramer, co-dathrusate
Dantron is genotoxic and carcinogenic


what are the side effects of Dantron ?

red urine
local irritation/ excoriation; avoid prolonged contact with skin in incontinent patients


What are other laxatives with stool softening properties ?

decussate sodium ( weak stimulant)
glycerol ( rectal stimulant)


If at least two laxatives ( from different classes ) have been tried at the highest tolerated doses for at least 6 months, which two other laxatives can be considered ?

consider prucalopride ( women only) or lubiprostone


What is the choice of treatment for opioid induced constipation ?

osmotic or decussate sodium + stimulant
methylnaltrexone/naloxegol: peripheral opioid receptor antagonist when response to laxatives inadequate
avoid bulk forming laxatives


What is the treatment for chronic constipation ?

same as for short duration


What is the treatment for constipation in children ?

add stimulant if inadequate response
add lactulose or faecal softener if stools remains hard


What is the treatment for constipation for pregnancy ?

1st line bulk forming
osmotic laxatives
bisacodyl or Senna if a stimulant effect is needed.