constipation

Question 1

what are the red flags of constipation?

Answer 1

• weight loss
• blood in stools
• N&V
• drugs induced
• laxative abuses
• change in bowel movements
• if child is feeling week and dizzy

Question 2

what are drugs we are worried about for drug induced constipation?

Answer 2

• opiods
• hyoscine
• verapamil
• iron preps
• propranolol
• bendroflumethiazide
• chrlopehniramine
• SSRIs
• Tricyclic antidepressants
• Antacids containing aluminimum

Question 3

what is the lifestyle advice for constipation?

Answer 3

• increase fibre intake
• drink more fluids
• increase exercise
• do not hold when need to go

Question 4

what is first line treatment for constipation?

Answer 4

life style - no drug treatment

Question 5

what is the second line treatment for constipation/

Answer 5

BULK FORMING LAXATIVES

Question 6

what are examples of bulk forming laxatives?

Answer 6

Isphaghula husk, Sterculia and Methylcellulose

Question 7

how do bulk forming laxatives work?

Answer 7

• act by retaining water into the bowel and increasing faecal mass
• need sufficient water in order to work

Question 8

how long do bulk forming laxatives take to work?

Answer 8

12-24 hours but can take up to 2-3 days to have full effect

Question 9

when are bulk forming laxatives not advised?

Answer 9

opiod induced constipation

Question 10

what is third line treatment for constipation/

Answer 10

Osmotic or Stimulant laxatives

Question 11

what are examples of osmotic laxatives?

Answer 11

Macrogol and Lactulouse

Question 12

how long does it take for osmotic laxatives to work?

Answer 12

2-3 days

Question 13

how do osmotic laxatives work?

Answer 13

work by drawing water into the bowel

Question 14

what are examples of stimulant laxatives?

Answer 14

senna, bisacodyl and sodium picosulfate

Question 15

how do stimulant laxatives work?

Answer 15

they work by increasing water and electrolytes release by the intenstinal mucosa/

Question 16

how fast do stimulant laxatives take to work>

Answer 16

6-12 hours (good to take before bed)

Question 17

what are examples of stool softeners?

Answer 17

Docusat, Arachis oil and Glycerol

Question 18

what is the time of onset of stool softeners?

Answer 18

RAPID

can be under an hour

Question 19

what are the limitations for OTC?

Answer 19

● Ispaghula Husk: 6 years
● Lactulose: 10 years
● Senna: 18 years

Question 20

what should happen with constipation in pregnancy?

Answer 20

Constipation is common in pregnancy, possibly due to increased levels of progesterone, which relaxes the muscles of the gut. Another possible contributor is iron supplementation, which can lead to constipation as a side effect.
● Avoid stimulant laxatives, especially in the first trimester, otherwise follow the same procedure as above and ensure shortest-term laxative treatment where possible.