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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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Prepared by : Safaaraed


  • 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 .


  • age > 65 years
  • Women suffer from constipation more than men .
  • 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.
  • Non pharmacological :
  • Increase intake of fluids .
  • Increase exercise to increase and maintain bowel tone .
  • Bowel training to increase regularity.
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.

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 .

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.

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 .

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.

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 .

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

  • Adverse effects : diarrhea .

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 .

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 .

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