Constipation Management Quiz
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Questions and Answers

A fissure tends to cause less bleeding but much more severe pain on ______.

defecation

Insufficient dietary ______ is a common cause of constipation.

fiber

An adequate fluid intake is essential for well-being, and for both prevention and treatment of ______.

constipation

Many drugs can induce ______; some examples are analgesics and opiates.

<p>constipation</p> Signup and view all the answers

If one week use of treatment does not produce relief of symptoms, the patient should see the ______.

<p>doctor</p> Signup and view all the answers

Increasing the amount of dietary fiber, maintaining fluid consumption, and doing regular ______ are crucial for non-pharmacological management.

<p>exercise</p> Signup and view all the answers

Blood in stools and a change in bowel habit of ______ weeks or longer should prompt a visit to the GP.

<p>2</p> Signup and view all the answers

A diet rich in NSPs and with plenty of ______ is likely to prevent constipation.

<p>water</p> Signup and view all the answers

A laxative may be recommended to ease the immediate ______.

<p>problem</p> Signup and view all the answers

Bulk-forming laxatives are considered the first line of ______.

<p>treatment</p> Signup and view all the answers

Stimulant laxatives alter water and electrolyte transport and increase ______ motility.

<p>bowel</p> Signup and view all the answers

Senna is an example of a ______ laxative.

<p>stimulant</p> Signup and view all the answers

Castor oil is a traditional remedy for constipation that is no longer ______.

<p>recommended</p> Signup and view all the answers

Sennosides may cause discoloration of the urine, resulting in pink or ______ colors.

<p>red</p> Signup and view all the answers

Individuals with undiagnosed rectal bleeding should not use ______ laxatives.

<p>stimulant</p> Signup and view all the answers

The action of oral stimulant laxatives typically occurs within ______ to 12 hours.

<p>6</p> Signup and view all the answers

Constipation is characterized by the passage of hard, dry stools with difficulty in ______.

<p>excretion</p> Signup and view all the answers

Normal bowel habit may vary from three movements in 1 day to three in 1 ______.

<p>week</p> Signup and view all the answers

Constipation is more common in people over ______ years of age.

<p>65</p> Signup and view all the answers

Women suffer from constipation more often than ______.

<p>men</p> Signup and view all the answers

A diet insufficient in ______ can contribute to constipation.

<p>fiber</p> Signup and view all the answers

Constipation is often associated with abdominal ______, bloating and nausea.

<p>discomfort</p> Signup and view all the answers

Blood in the stool may arise from piles or an anal ______.

<p>fissure</p> Signup and view all the answers

If symptoms suggestive of obstruction are present, urgent ______ is necessary.

<p>referral</p> Signup and view all the answers

Tablet formulations of bisacodyl should not be crushed or chewed due to the ______ coating.

<p>enteric</p> Signup and view all the answers

Bulk laxatives work by swelling in the gut to absorb water and soften the ______.

<p>stool</p> Signup and view all the answers

The sodium content of bulk laxatives, such as sodium bicarbonate, should be considered in those requiring a restricted ______ intake.

<p>sodium</p> Signup and view all the answers

When recommending the use of a bulk laxative, the pharmacist should advise that an increase in ______ intake would be necessary.

<p>fluid</p> Signup and view all the answers

Bulk-forming agents should not be used if there is an obstructing ______ lesion.

<p>bowel</p> Signup and view all the answers

Osmotic laxatives work by creating an osmotic ______ to pull water into the intestines.

<p>gradient</p> Signup and view all the answers

Glycerin suppositories have an onset range of 15 minutes to 1 hour, while polyethylene glycol has a longer onset of 1 to ______ days.

<p>3</p> Signup and view all the answers

Sugar-free formulations of bulk-forming laxatives should be considered for individuals with ______.

<p>diabetes</p> Signup and view all the answers

Lactulose works by maintaining the volume of fluid in the ______.

<p>bowel</p> Signup and view all the answers

Epsom salts act by drawing water into the ______.

<p>gut</p> Signup and view all the answers

Emollient laxatives create a softer stool by allowing water to move more easily into the ______.

<p>stool</p> Signup and view all the answers

The onset of emollient laxatives is ______ (24 to 72 hours).

<p>slow</p> Signup and view all the answers

Saline laxatives work by drawing water into the ______.

<p>colon</p> Signup and view all the answers

Mineral oil is an example of a ______ laxative.

<p>lubricant</p> Signup and view all the answers

Lactulose and lactitol can cause flatulence, cramps, and abdominal ______.

<p>discomfort</p> Signup and view all the answers

Repeated use of Epsom salts can lead to ______.

<p>dehydration</p> Signup and view all the answers

Elderly patients are at greater risk of developing ______ due to several factors.

<p>constipation</p> Signup and view all the answers

Mineral oil is contraindicated in individuals with ______ bleeding.

<p>rectal</p> Signup and view all the answers

Oral iron intake during ______ may contribute to the problem of constipation.

<p>pregnancy</p> Signup and view all the answers

Patients with chronic constipation may enter a vicious circle due to the use of ______ laxatives.

<p>stimulant</p> Signup and view all the answers

Sufficient dietary ______ and fluid intake may resolve constipation in children.

<p>fiber</p> Signup and view all the answers

Emollient and lubricant laxatives increase the systemic absorption of ______ oil.

<p>mineral</p> Signup and view all the answers

A single glycerin suppository may be appropriate along with dietary ______ for children dealing with constipation.

<p>advice</p> Signup and view all the answers

Maintaining fluid intake is crucial for preventing intestinal ______ in elderly patients using bulk laxatives.

<p>obstruction</p> Signup and view all the answers

Study Notes

Community Pharmacy Lecture 4

  • Lecture by Dr. Sahar Badr, Associate Professor of Clinical Pharmacy
  • Topic: Constipation

Constipation

  • Definition: A change in bowel movement frequency from the patient's normal pattern, characterized by passing hard, dry stools with difficulty and infrequent straining.
  • Normal Bowel Habit: Ranges from 3 bowel movements per day to 3 per week. Patients experiencing constipation typically complain of difficult-to-pass, hard stools less frequently than usual. A sudden change lasting 2 weeks or longer warrants referral to a GP.
  • Causes:
    • Lifestyle: Poor diet (low fiber, insufficient fluid), lack of exercise, and poor bowel habits.
    • Medications: Narcotic analgesics, anticholinergics (e.g., antidepressants or antihistamines), iron supplements, calcium or aluminum antacids, and NSAIDs.
    • Pregnancy: Increased uterus size, hormonal shifts, intake of prenatal vitamins (iron/calcium), reduced physical activity.
    • Systemic Disorders: Intestinal obstruction, tumors, inflammatory bowel disease (IBD), hypothyroidism, irritable bowel syndrome (IBS).
    • Other Factors: Poor diet, lack of exercise, not enough water, poor toilet habits, stress, laxative abuse, bowel cancer, potty training, travelling.

Epidemiology of Constipation

  • Age: More prevalent in individuals over 65 years old.
  • Gender: Women experience constipation more often than men.

Associated Symptoms

  • Often accompanied by abdominal discomfort, bloating, and nausea.
  • Severe cases can cause bowel obstruction, evidenced by colicky abdominal pain and vomiting.
  • Urgent referral is needed with obstruction symptoms.

Blood in the Stool

  • Can be associated with constipation.
  • Potential causes: piles (hemorrhoids), anal fissure (small crack in anus skin).
  • Associated with low fiber diet.
  • Piles may cause discomfort on defecation.
  • Anal fissures are usually more painful on defecation.

Diet

  • Insufficient dietary fiber is common cause of constipation.
  • Changes in diet or lifestyle (e.g., job change, loss of work, retirement, travel) can contribute.
  • Inadequate fluid intake is a significant factor.
  • Adequate fluid intake is essential for prevention and treatment. Increasing water intake alongside increased fiber is beneficial. The recommended fluid intake for adults is 2.5 liters per day.

Medications (Continued)

  • Continuous use of stimulant laxatives may cause a vicious cycle.
  • Repeated use may result in loss of muscular activity in the colon (atonic colon).
  • This can lead to chronic constipation.
  • Many drugs can induce constipation, including:
    • Analgesics and opiates (e.g., dihydrocodeine, codeine)
    • Antacids (e.g., aluminum salts)
    • Anticholinergics (e.g., hyoscine)
    • Anticonvulsants (e.g., phenytoin)
    • Antidepressants (e.g., tricyclics, selective serotonin reuptake inhibitors)
    • Antihistamines (e.g., chlorpheniramine, promethazine)
    • Antihypertensives (e.g., clonidine, methyldopa)
    • Anti-Parkinson agents (e.g., levodopa)
    • Beta-blockers (e.g., propranolol)
    • Iron
    • Laxative abuse
    • Monoamine oxidase inhibitors (MAOIs)
    • Antipsychotics (e.g., chlorpromazine)

When to Refer to a GP

  • Changes in bowel habits lasting 2 weeks or longer.
  • Abdominal pain, vomiting, or bloating.
  • Blood in the stool.
  • Prescribed medications suspected of causing symptoms.
  • Failure of over-the-counter (OTC) medications to resolve symptoms.

Management

  • Treatment Timescale: If one week of treatment does not provide relief, consult a doctor.
  • Non-Pharmacological Management:
    • Increase dietary fiber intake.
    • Maintain fluid intake.
    • Incorporate regular exercise.
    • Establish regular bowel training to ensure adequate time for defecation.
    • Diet rich in non-starch polysaccharides (NSPs) and adequate water.
    • Laxative may help in the short term for immediate relief.
  • Pharmacological Treatment:
    • Step-wise approach, starting with bulk-forming laxatives.
    • Osmotic laxatives as a second option.
    • Only use stimulant laxatives if previous steps are ineffective or intolerable.
    • Self-care limited to 7 days.

Classification of Laxatives

  • Stimulant
  • Bulk
  • Osmotic
  • Emollient
  • Saline
  • Lubricant

Specific Laxative Types

  • Stimulant Laxatives:
    • Mechanism: Alters water and electrolyte transport, stimulating bowel motility.
    • Usage: Recommended when bulk or osmotic laxatives fail.
    • Examples: anthraquinones (e.g., senna, sennosides), diphenylmethane (e.g., bisacodyl).
    • Warnings: Not for prolonged use, potential for overuse, bowel damage, and rectal bleeding, potential discoloration in urine, do not crush tablets.
  • Bulk Laxatives:
    • Mechanism: Swells in the gut, absorbing water, softening stool, increasing bulk, stimulating peristalsis.
    • Usage: Suitable when patients can't/won't increase fiber intake.
    • Examples: methylcellulose, psyllium, calcium polycarbophil, wheat dextran.
    • Precautions: Increased fluid intake required to prevent intestinal obstruction, granules mixed with liquid before use.
  • Osmotic Laxatives:
    • Mechanism: Creates osmotic gradient pulling water into the intestine, increasing peristalsis.
    • Examples: glycerin suppositories, polyethylene glycol, Epsom salts (magnesium sulfate), lactulose.
    • Warnings: Potential for mild side effects like rectal burning, cramping, diarrhea, flatulence.
  • Emollient Laxatives:
    • Mechanism: Allows more water into the stool, creating a softer consistency for easier passage.
    • Examples: Docusate sodium (DOSS), docusate calcium.
    • Precautions: Slow onset.
  • Saline Laxatives:
    • Mechanism: Draws water into the colon.
    • Examples: magnesium citrate, magnesium hydroxide, sodium phosphate.
    • Precautions: Potential for abdominal cramping, excessive urination, dehydration, and hypermagnesemia in those with pre-existing kidney conditions. Avoid in those with sodium restrictions.
  • Lubricant Laxatives:
    • Mechanism: Increases water retention in the stool.
    • Examples: Mineral oil.
    • Precautions: Potential for aspiration, liver toxicity if used with other laxatives and potential for overdose. Contraindicated for extended use. Not used at bedtime.

Constipation in Specific Populations

  • Children: Often due to diet or emotional factors. Dietary advice, and possibly a glycerin suppository, are initial management steps. Medical referral if unsuccessful.
  • Elderly: Can be exacerbated by lack of physical activity, tooth problems (causing avoidance of high-fiber foods), and multiple medications. Adequate fluid intake is critical when considering bulk laxatives.
  • Pregnancy: Hormonal changes and oral iron contribute to the problem. Avoid stimulant laxatives. Prefer bulk-forming laxatives.

Laxative Abuse

  • Two main groups:
    • Those with chronic constipation developing a vicious cycle of constipation and laxative misuse resulting in nerve damage.
    • Those with weight issues, including eating disorders (anorexia nervosa or bulimia), using laxatives to control weight.

General Notes

  • The intensity of a laxative effect is dose-dependent.

  • Senna can be combined with a stool softener.

  • Bisacodyl tablets are enteric-coated and should be swallowed whole.

  • Non-standardized products, such as senna pods or cascara, require caution due to unpredictable doses and actions.

  • Additional information on symptoms and differential diagnoses of other conditions are not mentioned

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Community Pharmacy Lecture 4 PDF

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Test your knowledge on the causes, treatments, and dietary recommendations for managing constipation. This quiz covers essential topics related to fluid intake, dietary fiber, and the use of laxatives. Perfect for those studying health, nutrition, or medicine.

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