Constipation
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Constipation . Prepared by : Safaa raed Baraa maher. Definition . Constipation is defined as a decrease in the frequency of fecal elimination and is characterized by the passage of hard, dry , and sometimes painful stools .

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Constipation

Constipation

Prepared by : Safaaraed

Baraamaher


Definition

Definition

  • Constipation is defined as a decrease in the frequency of fecal elimination and is characterized by the passage of hard, dry , and sometimes painful stools .

  • Patients may experience abdominal bloating , headaches , low back pain .


Constipation

Epidemiology

  • age > 65 years

  • Women suffer from constipation more than men .


Causes

Causes

  • Diet (a) insufficient dietary fiber.

    (b) inadequate fluid intake.

  • Lack of exercise .

  • Medication e.g ( anticholinergics )

  • Pregnancy


Pharmacist should question the patient about the following

Pharmacist should question the patient about the following

  • Normal stool frequency .

  • Duration of the constipation .

  • Frequency of constipation episodes.

  • Exercise routine.

  • Amount of dietry fiber consumed and fluid intake.

  • Presence of other symptoms

  • Current medication

  • Medications used to relive constipation and their effectiveness.


Treatment

Treatment

  • Non pharmacological :

  • Increase intake of fluids .

  • Increase exercise to increase and maintain bowel tone .

  • Bowel training to increase regularity.


Pharmacological

Pharmacological :

  • Bulk forming laxatives natural or synthetic polysaccharide derivatives that adsorb water to soften the stool and increase bulk which stimulates peristalsis . It acts in both the small and the large intestines.

  • Natural pysllium , Malt soup extract.

  • Synthetic methylcellulose,polycarbophil.


Constipation

  • Adverse effects : abdominal cramping,

    flatulence .

  • Administration guidelines :

  • Should not be used if patients have an obstructing bowel lesion .

  • Some bulk forming medications may contain sugar , so patients with diabtes should use sugar free products.

  • Should not use for more than 1 week to treat constipation .


Constipation

  • saline and osmotic laxatives work by creating an osmotic gradient to pull water into the small and large intestines . This increased volume results in distention of the intestinal lumen , causing increased peristalsis and bowel motility.

  • Saline laxatives sodium and magnesium salts .

  • Osmotic laxatives glycerin, lactulose, sorbitol, polyethlene glycol.


Constipation

  • Adverse effects : diarrhea , abdominal pain .

  • Administration guidelines :

  • Patient should consume 8 oz. of water to prevent possible dehydration .

  • Patient with HTN or CHF should not receive saline laxatives owing to fluid retention from sodium absorption .

  • Patients with sever kidney disease should not use products containing magnesium .


Constipation

  • Stimulant laxatives work in the small intestines to stimulate bowel motility and increase the secretion of fluids into the bowel.

  • Includes :

  • Anthraquinone laxatives senna .

  • Diphenylmethane derivative Bisacodyl .

  • Castor oil .

  • Adverse effects : abdominal cramping , fluid and electrolyte deficienes.


Constipation

Administration guidelines

  • Patients with signs of intestinal obstruction should not use stimulant laxatives.

  • Possible carcinogenicity of stimulant laxatives.

  • Chronic use lead to cathartic colon , which results in a poorly functioning colon and resembles the symptoms of ulcerative colitis .


Constipation

  • Emollient laxatives act as surfactant by allowing absorption of water into the stool which makes the softened stool easier to pass.

  • Adverse effects : diarrhea .


Constipation

  • Lubricant laxative increase water retention in the stool to soften the stool .

  • Adverse effect : perianal discomfort .

  • Administration guidelines :

  • Should be taken on empty stomach .

  • Should not be given to children < 6 years.

  • Should not be given to patients with rectal bleeding or appendicitis.


Special patient issues

Special patient issues

  • Pediatric patients during the first weeks of life,infants pass approximately 4 stools /day.

  • As get older, approximately 1-3 stools are passed per day .

  • Treatment : increasing the amount of fluid or sugar in a child's formula , glycerin suppositories and magnesium laxatives, enemas should not be used in children <2 years .


Constipation

  • Pregnant patients constipation is common and is often the result of compression of the colon by the enlarged uterus.

  • Pregnant patients should use bulk forming agents or stool softeners .

  • Geriatric patients at risk for constipation because of insufficient fiber and fluid intake , failure to establish a regular bowel time habit and abuse of stimulant laxatives .


Constipation

  • Glycerin suppositories or orally administered lactulose may be useful for initial treatment of constipation and bulk forming agents used to prevent constipation .


Some medications in the market

Some medications in the market


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