Constipation in pregnancy TOG 2015 Flashcards
How common is constipation in pregnancy?
40%
Which criteria can be used to score chronic constupation?
ROME III criteria
1 Must include two or more of the following:
a. Straining during at least 25% of defecations
b. Lumpy or hard stools in at least 25% of defecations
c. Sensation of incomplete evacuation for at least 25% of defecations
d. Sensation of anorectal obstruction/blockage for at least 25% of defecations
e. Manual manoeuvres to facilitate at least 25% of defecations (e.g., digital evacuation, support of the pelvic floor)
f. Fewer than three defecations per week
2. Loose stools are rarely present without the use of laxatives
3. Insufficient criteria for irritable bowel syndrome
What is the cause of increased rates of consitpation in pregnancy?
High levels of progesterone, reduce intestinal smooth muscle motility
1st line treatment of constilation
Increase fibre and fluid intake
1st line laxative in pregnancy?
Bulk forming agents
Ispaghula husk
Bulk faecal mass, stimulating peristalsis - take a few days to work
No effect to fetus
When are bulk forming agent contraindicated?
Faecal impaction
How to osmotic laxatives work, examples? SE?
Increase osmolar tension, increase water into cooling, aiding peristalsis,
Lactulose, polethylene glycol
SE: Faltulance, abdo blating, inestimable sugars - should ne avoided in DM
What is Movicol
A macrocell which are inert polymers of ethylene glycol so are also consider osmotic laxative. No licensed in pregnancy but effects are thought to be negligible.
How do stimulant laxatives work? Examples?
Large intestine - reduce water absorbtion, colonic hyper-motility
Bisacodyl and Senna
Safety in pregnancy of stimulants?
Avoid in 3rd trimester as can stimulate uterine contraction
Senna is excreted in breastmilk, so caution.
Bisacodul consider safe in prengnacy
What time of laxative is docusate? Can it be used in pregnancy?
Stimulant and softening agent
Case of neonatal hypomagnesaemia
Only use in small doses and if other treatments have failed.
Excreted in breast milk
Can suppositories and enemas be used in pregnancy?
Glycerine suppositions are safe
No data on enemas
When to refer to gastroenterologist?
A change in bowel habit for longer than 6 weeks.
Rectal bleeding.
Known history of gastrointestinal disorders such as inflammatory bowel disease.
A family history of colorectal cancer.
