What are the symptoms of constipation?
• Passage of hard, dry stools
• Less frequent bowel movements than normal or at least 3 times during the last week
• Abdominal discomfort, bloating, and nausea
• Straining or pain during bowel movements
Constipation symptoms can vary in severity and presentation.
When should a patient be referred for constipation?
• If constipated for more than 14 days
• If constipated for more than 7 days in children
• If constipation is accompanied by weight and appetite loss
• If there are tarry, red, black, or bloody stools
• If constipation presents with weight gain, lethargy, coarse hair, or dry skin
These signs may indicate serious underlying conditions.
What are common causes of constipation?
• Not enough fiber
• Not drinking enough fluids
• Lack of exercise
• Certain medications (e.g., opioids, iron, tricyclic antidepressants)
Medications can often lead to constipation, so review is necessary.
What is the first-line treatment for constipation?
• Manage any underlying causes
• Increase fruit and fiber intake
• Keep hydrated (up to 2L per day)
• Regular exercise (30-60 mins on 5 or more days a week)
• Encourage proper toileting routines
Lifestyle changes are crucial in managing constipation.
What are bulk-forming laxatives, and how do they work?
• Examples: ispaghula (Fybogel), methylcellulose
• MOA: swell in the gut to increase faecal mass, stimulating peristalsis
• Takes 2-3 days to reach full effect
• Side effects: flatulence, abdominal pain
Bulk-forming laxatives are generally considered safe.
What are the characteristics of osmotic laxatives?
• Examples: lactulose, macrogols (Movicol, Laxido)
• MOA: retain fluids in the bowel by osmosis
• Must drink plenty of water to avoid dehydration
• Takes 2-3 days to work
Osmotic laxatives are effective for hard stools.
What should be cautioned about stimulant laxatives?
• Examples: Bisacodyl (Dulcolax), Senna (Senokot)
• Increase motility by stimulating peristalsis
• Effects can be seen within 6-12 hours or quicker with suppositories
• Side effects: abdominal pain, hypokalaemia, lazy bowel
Stimulant laxatives should be used cautiously due to potential side effects.
What are the symptoms of diarrhea?
• Increased frequency of bowel evacuation
• Abnormally soft or watery faeces
• Abdominal cramps
• Flatulence
• Nausea and weakness
Diarrhea usually lasts up to 5-7 days.
What are some potential causes of diarrhea?
• Conditions: Crohn’s disease, IBS, lactose intolerance, ulcerative colitis, coeliac disease
• Drugs: NSAIDs, magnesium, antibiotics, diuretics
• Bacterial or viral infections
Identifying the cause is crucial for effective treatment.
When should a patient be referred for diarrhea?
• Signs of dehydration in babies or children
• Diarrhea lasting more than 7 days
• Bloody diarrhea or mucus in stools
• Inability to drink fluids
These situations may indicate serious health concerns.
What is the first-line treatment for diarrhea?
• Oral Rehydration Therapy (ORT): Dioralyte
• Suitable for all ages, safe in P+BF
• Formulated to replace lost fluids and salts
ORT is essential for preventing dehydration.
What is the mechanism of action of loperamide?
• High affinity for opiate receptors in the gut wall
• Reduces gut motility
• Recommended for patients over 12 years of age
Loperamide is effective for managing acute diarrhea.
What are the symptoms of heartburn and indigestion?
• Heartburn: burning pain from stomach to esophagus
• Indigestion: pain from chest to upper abdomen
• Symptoms: bloating, flatulence, nausea, vomiting
Peptic ulcers may also cause similar symptoms.
What are some causes that can worsen heartburn or indigestion?
• Foods: coffee, alcohol, chocolate, fatty/spicy foods
• Smoking
• Stress
• Pregnancy
• Overweight
Lifestyle factors play a significant role.
What are the first-line treatments for heartburn and indigestion?
• Alginates (e.g., Gaviscon)
• Antacids (e.g., Rennie)
These medications help manage symptoms effectively.
What are proton pump inhibitors (PPIs) and their cautions?
• Examples: omeprazole, pantoprazole, esomeprazole
• Short-term use recommended for 14 days
• Can mask symptoms of gastric cancer
• Side effects: abdominal pain, constipation, diarrhea
PPIs should be used with caution, especially in older patients.
What are the symptoms of Irritable Bowel Syndrome (IBS)?
• Alternating diarrhea and constipation
• Abdominal pain/spasms
• Bloating/discomfort
• Symptoms must present for 6 months or more
IBS usually affects individuals under 45 years old.
When should a patient be referred for suspected IBS?
• All children with suspected IBS
• Adults over 45 with new symptoms
• Loss of appetite, fever, nausea, vomiting
• Rectal bleeding
These symptoms could indicate more severe conditions.
What are the symptoms of bloating/discomfort?
Symptoms include bloating and discomfort.
Diagnosis is based on symptoms presenting for 6 months or more.
What is the typical age group affected by bloating/discomfort?
Usually affects individuals under 45 years old.
What relieves bloating/discomfort?
Relieved by defecation and passing of wind.
When should children be referred if IBS is suspected?
All children must be referred.
What are the referral cautions for adults over 45 presenting with IBS symptoms?
Adults >45 years old presenting with symptoms for the first time, loss of appetite, fever, nausea and vomiting, rectal bleeding, weight loss or steatorrhea, a hard lump or swelling in the gut area.
What is the primary treatment for IBS?
Antispasmodics such as Hyoscine.
