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Management of Constipation in Adults

Management of Constipation in Adults. Stephen Aglubat, MD May 2012. Objectives. Define Constipation Treatment options for constipation. Case.

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Management of Constipation in Adults

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  1. Management of Constipation in Adults Stephen Aglubat, MD May 2012

  2. Objectives • Define Constipation • Treatment options for constipation

  3. Case • 76 year old female with PMHx of HTN, DMII, HLD, presents to the clinic. She’s complaining of having stools only twice a week, and feeling “full.” She’s eating more vegetables, started drinking more water, and she recently included Metamucil to her diet. Her last colonoscopy one year ago was clean. She comes to your office to be evaluated for her constipation. What would you offer her for the constipation? • A. Lactulose • B. Senna • C. Docusate • D. Weekly tap water enemas

  4. Definition • Rome III criteria: 2 of the below defines constipation • Straining • Lumpy Hard Stools • Incomplete Evacuation • Use of Digital Rectal Maneuvers • Sensation of Anorectal Blockage • < 3 Bowel Movements per week

  5. Pathophysiology I • Constipation is caused by: • Primary Colorectal dysfunction • Slow Transit • Dyssnerygic Defacation • Irritable Bowel Syndrome

  6. Pathophysiology II • Constipation is caused by: • Secondary Causes • Endocrine/Metabolic • Neurologic • Myogenic Disorders • Medications • Obstruction • Chronic Idiopathic Constipation (CIC)

  7. Management • Initial treatment of Chronic Functional Constipation • Lifestyle modification • Diet and fiber

  8. Lifestyle Modifications • Increased fluid intake • Exercise • Establish regular bowel regimen pattern

  9. Diet and fiber • Fiber increases bulk/distension • Distention causes stool propulsion. • >25 g of fiber/day • Effect may take weeks. • Adverse effects: Bloating, flatulence

  10. Laxatives I • Stimulant Laxatives • Senna • Bisacodyl

  11. Laxatives II • Bulk forming laxatives • Psyllium (Metamucil) • Methylcellulose (Citrucel) • Polycarbophil (FiberCon) • Dextran (Benefiber)

  12. Laxatives III • Osmotic Laxatives • Polyethylene glycol • Lactulose • Sorbitol • Magnesium Hydroxide

  13. Other therapies • Colonic secretagogues • Lubipristone

  14. Summary • Constipation in the older adult may be due to chronic constipation, secondary etiologic factors • A thorough history must be obtained to rule out secondary causes. • Therapy includes: • Diet/lifestyle • Stimulant Laxatives • Osmotic Laxatives

  15. Case • 76 year old female with PMHx of HTN, DMII, HLD, presents to the clinic. She’s complaining of having stools only twice a week, and feeling “full.” She’s eating more vegetables, started drinking more water, and she recently included Metamucil to her diet. Her last colonoscopy one year ago was clean. She comes to your office to be evaluated for her constipation. What would you offer her for the constipation? • A. Lactulose • B. Senna • C. Docusate • D. Weekly tap water enemas

  16. Case • 76 year old female with PMHx of HTN, DMII, HLD, presents to the clinic. She’s complaining of having stools only twice a week, and feeling “full.” She’s eating more vegetables, started drinking more water, and she recently included Metamucil to her diet. Her last colonoscopy one year ago was clean. She comes to your office to be evaluated for her constipation. What would you offer her for the constipation? • A. Lactulose • B. Senna • C. Docusate • D. Weekly tap water enemas

  17. References • 1. Management of chronic constipation in older adults. Wald, Arthur. Uptodate.com. March 2012

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