Podcast
Questions and Answers
Which medication class is known to commonly cause constipation?
Which medication class is known to commonly cause constipation?
Why are bulk-forming laxatives not recommended for opioid-induced constipation?
Why are bulk-forming laxatives not recommended for opioid-induced constipation?
What is the mechanism of action for stimulant laxatives like senna and bisacodyl?
What is the mechanism of action for stimulant laxatives like senna and bisacodyl?
Which of the following statements about constipation patient education is false?
Which of the following statements about constipation patient education is false?
Signup and view all the answers
Which of the following is a common myth about constipation treatment?
Which of the following is a common myth about constipation treatment?
Signup and view all the answers
What lifestyle factor is often associated with an increased risk of constipation?
What lifestyle factor is often associated with an increased risk of constipation?
Signup and view all the answers
Which demographic is least likely to experience constipation?
Which demographic is least likely to experience constipation?
Signup and view all the answers
Which condition is not typically associated with constipation?
Which condition is not typically associated with constipation?
Signup and view all the answers
Which medication class is associated with potentially causing constipation?
Which medication class is associated with potentially causing constipation?
Signup and view all the answers
What is the mechanism of action of bulk-forming laxatives?
What is the mechanism of action of bulk-forming laxatives?
Signup and view all the answers
What is an appropriate counseling point for patients using bulk-forming agents?
What is an appropriate counseling point for patients using bulk-forming agents?
Signup and view all the answers
Which of the following myths about constipation is incorrect?
Which of the following myths about constipation is incorrect?
Signup and view all the answers
What factor is most likely contributing to constipation in a young female marathon runner taking diphenhydramine?
What factor is most likely contributing to constipation in a young female marathon runner taking diphenhydramine?
Signup and view all the answers
Which population is typically recommended to use bulk-forming agents?
Which population is typically recommended to use bulk-forming agents?
Signup and view all the answers
What is the expected onset time for bulk-forming laxatives?
What is the expected onset time for bulk-forming laxatives?
Signup and view all the answers
What instruction should be emphasized to patients regarding the use of laxatives?
What instruction should be emphasized to patients regarding the use of laxatives?
Signup and view all the answers
Which class of medication is considered first-line for treating constipation?
Which class of medication is considered first-line for treating constipation?
Signup and view all the answers
What is the mechanism of action for bulk-forming laxatives?
What is the mechanism of action for bulk-forming laxatives?
Signup and view all the answers
What is a potential side effect of using bulk-forming laxatives?
What is a potential side effect of using bulk-forming laxatives?
Signup and view all the answers
Which of the following laxatives is classified as a hyperosmotic laxative?
Which of the following laxatives is classified as a hyperosmotic laxative?
Signup and view all the answers
What educational advice should be given to a patient starting bulk-forming laxatives?
What educational advice should be given to a patient starting bulk-forming laxatives?
Signup and view all the answers
What should a patient do if there is no improvement in constipation after 7 days of self-treatment?
What should a patient do if there is no improvement in constipation after 7 days of self-treatment?
Signup and view all the answers
Which laxative is generally not recommended due to the risk of aspiration pneumonia?
Which laxative is generally not recommended due to the risk of aspiration pneumonia?
Signup and view all the answers
Which dietary change is recommended alongside laxative use for constipation relief?
Which dietary change is recommended alongside laxative use for constipation relief?
Signup and view all the answers
What common misconception about constipation treatment may lead patients to avoid necessary medications?
What common misconception about constipation treatment may lead patients to avoid necessary medications?
Signup and view all the answers
Which of the following is NOT a method of non-pharmacologic therapy for constipation?
Which of the following is NOT a method of non-pharmacologic therapy for constipation?
Signup and view all the answers
Study Notes
Constipation: A New View for the 2020s
- Prevalence: 2-28% of the US population; women are 3x more likely than men to experience constipation
- Consequences: 2.5 million physician visits/year; $1.4 billion in combined sales of enemas and laxatives
Constipation: Symptoms
- Straining to have a bowel movement
- Hard, dry stools
- Small stools
- Feeling as though bowel evacuation is incomplete (tenesmus)
- Decreased stool frequency
Causes of Constipation
-
Medications: antihistamines, anticholinergic drugs, antidepressants, calcium channel blockers, calcium supplements and antacids, diuretics, iron supplements, opioids.
- Opioid-induced Constipation: First-line therapy: stimulant laxative (senna/bisacodyl) ± docusate or polyethylene glycol (PEG) 3350 scheduled daily. Bulk-forming laxatives are NOT used due to the risk of fecal impaction.
- Conditions: dementia, depression, diabetes, irritable bowel syndrome, multiple sclerosis, neurologic disorders, Parkinsonism, stroke, thyroid disorders.
- Lifestyle: low calorie or low fiber diet, dehydration, inactivity, urge avoidance.
- Special Populations: postpartum patients, older adults, patients with colostomies, irritable bowel syndrome, or diverticular disease
Complications of Constipation
- Hemorrhoids
- Anal fissures
- Rectal prolapse
- Fecal impaction
Self-Treatment Exclusion
- Conditions: prolonged constipation, marked abdominal pain, distention, cramping, or flatulence, fever, nausea/vomiting, blood in stool or dark, tarry stool, sudden change in character of stool, weight loss.
- Special Populations: diabetics, children, pregnant women
SCHOLAR-MAC: A Mnemonic for History Taking
- Symptoms
- Characteristics
- History
- Onset
- Location
- Aggravating Factors
- Remitting Factors
- Medications
- Allergies
- Conditions
Treatment Goals
- Relieve: Relieve symptoms and reestablish normal bowel function.
- Establish: Establish dietary and exercise habits to prevent recurrence.
- Promote: Promote safe and effective use of laxatives, if indicated.
Non-Pharmacologic Therapy
- Hydrate: 64 fl oz (~ 1.9 liters) per day
- Increase fiber intake: 25 g for females and 38 g for males, gradually increase over 1-2 weeks to avoid abdominal discomfort.
- Increase physical activity.
- Behavioral modifications: bowel training and toileting positioning.
- Juice: plum or prune juice (3-4 g fiber per serving), sorbitol-containing juices (prune, apple, and pear).
Pharmacotherapy
-
Bulk-forming agents: Considered first-line treatment as they closely approximate the physiological process.
- Mechanism of action: swell in the presence of intestinal fluid to facilitate defecation.
- Options: methylcellulose (Citrucel®), calcium polycarbophil (Fibercon®), psyllium (Metamucil®, Konsyl®), wheat dextrin (Benefiber®).
- PEG 3350: Use if bulk-forming agents are ineffective or faster onset is desired.
- Stimulant laxatives: Use if PEG 3350 is ineffective.
- Referral: Refer to a healthcare professional if no improvement after 7 days of self-treatment.
Medications Classes
- Bulk-forming laxatives: Increase stool bulk by swelling in water to form an emollient gel or viscous solution, promoting peristalsis (e.g., methylcellulose, psyllium).
- Hyperosmotic laxatives: Increase water content in the intestines, stimulating bowel movement (e.g., polyethylene glycol, magnesium hydroxide).
- Mineral oil: Softens fecal contents, but not recommended due to potential for aspiration pneumonia and adverse events.
- Stimulant laxatives: Stimulate the muscles in the intestines, increasing bowel movement (e.g., senna, bisacodyl).
- Stool softeners: Soften stool by decreasing water absorption in the intestines (e.g., docusate).
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
