Diarrhoea and Constipation By Priyanca Patel. What is Constipation? Infrequent bowel movements due...
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Transcript of Diarrhoea and Constipation By Priyanca Patel. What is Constipation? Infrequent bowel movements due...
What is Constipation?Infrequent bowel movements due to increased transit time or pelvic dysfunction
What factors could cause constipation?
• Age• Physiology• Medication
• Opioids• Anticholinergics• TCAs• CCBs
• Diet• Illness or
disorder• Hormonal
What treatment options are available for constipation?
Lifestyle: Changes in diet and exercise habits
Purgatives: accelerate transit of faeces through the intestine
What are the 4 main classes of purgatives?Faecal softeners
Osmotic laxatives
Bulk laxatives
Stimulant laxatives
Alter fecal consistency
Surface acting compounds
Act slowly (3-5 days) to keep stools soft
Used for constipation and fissures/ piles
Docusate- softens faeces
Mineral oils- lubrication
Fecal Softeners
Osmotic LaxativesPoorly absorbed solutes
Maintain an increased volume of fluid in GI tract, therefore accelerating transit time
Saline purgatives- Mg sulphate and Mg hydroxide used for bowel prep prior to procedure as rapidly acting
Lactulose- semi synthetic disaccharide (fructose and glucose) 2 poorly absorbed monosaccharaides (by colonic bacteria) fermentation yields lactic acid + acetic acid. Acts in 1-3 days and can be prescribed alongside opioids
Bulk LaxativesPolysaccharide polymers that are NOT broken
down by the normal process of digestion
Retain water in the GI lumen, softening and increasing fecal bulk and promote motility
Eg. Methylcellulose and plant gums such as bran, agar or ispaghula husk
Faster acting- 1-3 days
Good first choice for constipation and IBS
Stimulant laxatives- Senna + Bisacodyl
Contains a glycoside which passes unchanged into the colon
Bacteria act upon it to release free anthrancene derivatives which have a direct effect upon the myenteric plexus
Usually taken at night and takes around 8hrs to work
Short term use is safe but abuse melanosis coli and/or cathartic colon
Bisacodyl usually given as a suppository
Stimulates rectal mucosa mass movements and defecation in 15-30mins
What is diarrhoea?Frequent, watery, loose bowel movements involving increased GI motility and secretion and decreased absorption of water
What factors could cause diarrhoea?• Infectious agents• Toxins• Anxiety• Drugs
• Antibiotics• PPIs• Antidepressants
What are the 4 main types of diarrhoea?Motility-related diarrhoea
Osmotic diarrhoea
Inflammatory diarrhoea
Secretory diarrhoea
What are the main treatments for diarrhoea?Maintenance of fluid/ electrolyte balance
(ESP. Na+ and K+)
Anti-infective agents
Anti-diarrheal agents