Constipation

Question 1

What are the causes of constipation?

Answer 1

• Poor fibre intake
• Poor fluid intake
• Sedentary lifestyle
• Other medication

Question 2

What are the signs and symptoms of constipation?

Answer 2

• Reduced Frequency of defecation compared to what is normal for that person
• Straining and passage if small, hard stools.
• Abdominal discomfort
• Abdominal cramps
• Feeling of incomplete emptying of bowels after going to the toilet.

Question 3

What are the referral symptoms of constipation?

Answer 3

• Blood in the stools
• Pain on defecation
• With abdominal pain, vomiting or bloating.
• Unexplained weight loss
• Failed treatment
• Change in bowel habit of more than 2 weeks.
• Adults with new or worsening constitution without adequate explanation.

Question 4

What are the OTC Treatments of constipation?

Answer 4

• Laxatives
  → Bulk forming
  → Osmotic
  → Stimulant
• Stool softener

Question 5

What are the treatment options for constipation in special patient groups?

Answer 5

Children:
- Normally resolves without treatment.
- Tummy ache, pain when attempting to pass stools, upset /anxious about going to the toilet.
- Fruit juice will help
- Referral to a GP if not resolved and danger symptoms present.
- If the constipation becomes regular , referral for prescribed treatment may be appropriate.
- ‘Toilet phobia’ needs to be avoided.
Pregnancy and breastfeeding:
- First line is lifestyle measures.
- Bulk Forming and osmotic laxatives are the safest options as they are not absorbed.
- Senna enters the breast milk, so may cause colic and diarrhoea in the infant.

Question 6

What is an example of bulk forming?

Answer 6

Ispaghula

Question 7

How does bulk forming work and when is it given?

Answer 7

• Act by retaining water in the gut and increasing faecal mass, therefore stimulating peristalsis.
• Have a delayed onset and therefore are not suitable for acute occasional relief.
• They must be taken with adequate fruits to avoid intestinal obstruction.
• Dissolve sachet in water and drink.
• Licensed for 6 years+

Question 8

What are some examples of osmotic treatments?

Answer 8

• Lactulose
• Macrogol

Question 9

How does osmotic work and when is it given?

Answer 9

• Act by increasing the absorption of water into the large bowel.
• Can take up to 48 hrs to be effective.
• Lactulose: liquid, licensed for used in babies.
• Macrogol: sachets, paediatric sachets and liquid, licensed from 2 year+ depending on formulation.

Question 10

What some examples of stimulants?

Answer 10

• Senna
• Bisacodyl

Question 11

How does stimulants work and when is it given?

Answer 11

• Act by stimulating colonic nerves to increase intestinal motility.
• They take effect within 8 to 12 hours, so the dose is usually taken at night.
• Frequent use can lead to fluid and electrolyte imbalance.
• Given orally: senna (licensed for 12 years+), bisacodyl (licensed for 12 years+)

Question 12

What are some examples of stool softeners?

Answer 12

• Docusate
• Glycerol

Question 13

How does stool softener work and when is it given?

Answer 13

• Act by reducing surface tension and increasing penetration of intestinal fluids into the faeces,
• Both are also stimulant laxatives.
• Docusate: given orally as liquids or capsules, licensing depends on formulation.
• Glycerol: given rectally, licensed for use in children, size of suppository used depends on age, useful for rapid relief