Constipation: Causes, Treatments, and Patient Education - PDF

Constipation Michael A. Zappone, Pharm.D. Assistant Professor, Department of Pharmacy Practice February 4, 2025 Learning Objectives Recognize the definition, pathophysiology, and causes of constipation. Recall the exclusions for self-treatment of constipation....

Constipation Michael A. Zappone, Pharm.D. Assistant Professor, Department of Pharmacy Practice February 4, 2025 Learning Objectives Recognize the definition, pathophysiology, and causes of constipation. Recall the exclusions for self-treatment of constipation. Review indications, dosing, and potential drug interactions for nonprescription medications that treat constipation. Evaluate a patient who presents with symptoms of constipation and identify if a medical referral is necessary. Design patient specific self-care treatment plans that include both nonpharmacologic and pharmacologic therapies for individuals presenting with constipation concerns. Constipation Overview General Fewer than 3 bowel movements per week with Definition: straining/difficult passage of hard, dry stools, or both Common Straining to have a bowel movement Patient Hard, dry stools Descriptions Small stools of Feeling bowel evacuation is incomplete Constipation Decreased stool frequency : Most likely Persons >65 (5 times more likely compared to younger adults) to Women (3 times more likely compared to men) experience: Late-term pregnancy Post-childbirth Reported more in persons of nonwhite ancestry Constipatio Relieve constipation and reestablish normal bowel function within n one week Treatment To establish dietary and exercise habits to help prevent recurrence Goals: To promote the safe and effective use of laxative products if indicated Pathophysiology of Constipation Persons Food ingested Anatomy of Digestive System With Normal Stomach: Retained ~3 hours (food Gastric partially digested) Motility Via peristaltic waves -> Duodenum Small intestine: Retained ~3 hours Large intestine (nondigestible material) Sigmoid colon (fecal matter stored until defecation - voluntary and involuntary reflexes control defecation) Rectum (internal anal sphincter relaxation-> fecal matter involuntarily propelled from colon into rectum) Voluntary tightening of abdominal wall muscles with relaxation of external anal Causes of Constipation Primary Causes Slower than normal GI transit time Defecatory disorders (ex. pelvic floor dysfunction) Secondary Causes Structural abnormalities Systemic, neurologic, and psychological conditions (ex. situational stress) Inadequate fluid intake (dehydration) Inadequate dietary fiber intake Failing to empty at appropriate time Lack of exercise MEDICATIONS Clinical Presentation of Constipation Self-reported decreased frequency or difficulty passing stools Anorexia Dull headache Lethargy Low back pain Abdominal discomfort Bloating Flatulence Psychosocial distress Treatment of Constipation Constipation Treatment Key Principles Occasional bouts of temporary constipation can USUALLY be managed with self-care measures Constipation continuing over several weeks to months or complicated by concurrent conditions requires more sustained and aggressive therapy Longstanding or untreated constipation complications: Hemorrhoids Anal fissures Rectal prolapse Fecal impaction Rectal ulcers Blood pressure surges or cardiac rhythm disturbances (straining) Constipation General Treatment Approach Lifestyle changes Increase intake of high fiber foods and fluids Regular exercise Consider pharmacologic therapy for more immediate relief U.S. Food and Drug Administration (FDA) labeling for nonprescription products limits their use to short-term (