Symptoms
- Passing less than 3x a week
- Straining
- Incomplete emptying
Referral
- Lethargy, weight gain, thinning hair, dry skin (hypothyroidism)
- Stimulant laxative abuse = lazy bowel syndrome
- Obstruction: vom, abdominal distention, colic pain
- > 2 weeks
First line
Lifestyle advice
Second line
Bulk forming
Osmotic
Stimulant
Stool softeners
Bulk forming
Ideal for small, hard stools
- Ispaghula husk 6+ (fybogel)
- Stercula 6+
- Methylcellulose
MOA: inc faecal mass, 2-3 days full effect
S/e: esophageal or intestinal obstruction, flatulence
Counsel: swallow w water + not immediately before bed
Osmotic laxatives
Ideal for hard stools
- Macrogol 12+/2-11 (movicol)
- Lactulose 3 months
- Magnesium sulphate 12+
MOA: inc water in colon, 2-3 days but 48H for lactulose
S/e: discomfort, flatulence + cramps
Stimulant laxatives
Stools soft but difficult to pass
- Senna 6+/12+ (colours urine brown)
- Bisacodyl 10+ (dulcolax)
- Sodium picosulphate 10+
- Docusate 18+
- MOA: inc intestinal motility, 6-12H
- Glycerin suppositories: 15-30 mins (4g adult, 2g <12, 1g infants)
- S/e: cramps, overuse = hypokalaemia, lazy bowel
- Counselling: take at night to go in morning
Counselling for rectal administration
Wash hands
Remove wrapper
Lie on side w lower leg straight + upper leg bent towards stomach
Lift upper buttocks
Insert pointed end first
Remain lying down for 5 minutes
Pregnant
Bulk forming (first line) or lactulose
Avoid stimulant (not licensed)
Elderly
Caution recommending bulk forming, risk of gut obstruction
Children
Lactulose first line after lifestyle
Opioid induced
Lactulose AND stimulant
Avoid bulk forming - risk of obstruction
Counselling
- 5 portions fruit + veg
- 2.5L liquid
- 30 min exercise
- 18-30g fibre a day
