Constipation

Constipation

Classified as
1. difficulty during defication /infrequent
2. Hard/pain/straining
  1. may lead to bleading/rectal prolapse
Causes
1. Lack of Dietary Fib/fluid
2. faecal impactation (dissabled/un mobile)
3. certain meds (opoids:codine)
prev better than cure!!!!
1. pharm treatments - laxatives:
  1. 1st - Bulk forming (ensure ad water) :
    1. fybogel
    2. dont use buling agent with opoid induced constipation/use osmotic + stimulant
      1. opioids block pain signals to brain - hence blocking the peristalsis msg that it stimulated with bulk forming laxitives
        Enteric n. system
        colonic nerves
    3. A: Distend the colon=peristalsis
  2. if soft but difficult to pass - Stimulant:
    1. senna kot (metobilised into its active metabolite by bacterial enzymes in large bowl
    2. A: inducing peristalsis
  3. faecal softeners /DUCOSATE:
    1. penut oil/ liquid parafin enema
  4. 2nd - add to /switch to : osmotic :
    1. lactalose
    2. A: Retain water in stool
  5. experts ad (NICE)- clear faecal impaction b4 treating chronic constp ; using step by step approach altering treatment to the patients needs
  6. Chronic Constp consideration - Laxatives
    1. hyd/bulking
    2. macrogols (osmotic effect)
      1. lacatalose
    3. stimulant
    4. Doses of above to be grad titrated up/down to produce / soft formed stools p/d (which can be assed on the bristol stool scale)
      1. if 2 or more lax comb have been trailed for 6mnts @ HIGHEST CONC
        MEN: LUBIPROSTONE
        WOMEN: PRUCLAOPRIDE
    5. oic
      1. lifestyle changes as with rest
      2. avoid bulking lax/use osmotic ,stimulating
2. Non Pharm
  1. inc exercise
  2. in hydration
  3. inc f/v
  4. reg meal pattern
  5. adjust any constipation meds if poss
Primary (no known cause)
secondary (meds/cond)
Red Flag
1. unintended weight loss
2. blood in stool

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