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Constipation

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Abdominal and Rectal pain. Flatulence. Loss of appetite. Lethargy. Depression ... No evidence that increased exercise is beneficial in severe constipation ... – PowerPoint PPT presentation

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Title: Constipation


1
Medications and Constipation in the Elderly
No organ in the body is so misunderstood, so
slandered and maltreated as the colon! Sir Arthur
Hurst, 1935
2
What is Constipation?
  • Patient Definition
  • Hard Stools
  • Infrequent stools (lt3 per week)
  • Excessive straining
  • Sense of incomplete bowel emptying
  • Excessive, unsuccessful time spent on toilet
  • Constipation is NOT a normal part of ageing.

3
Other symptoms of constipation
  • Nausea /- vomiting
  • Abdominal and Rectal pain
  • Flatulence
  • Loss of appetite
  • Lethargy
  • Depression

Patients may not associate these with constipation
4
What are some of the consequences of constipation
in the elderly?
  • Nausea and reduced appetite ? weight loss
  • Behavioural disturbances in dementia ? increased
    use of psychotropic medications
  • Extra staff time needed for increased toiletting
    needs
  • Overall increased number of medications in the
    regime

5
Increased prevalence of Secondary Causes..
Why does constipation become a problem in the
elderly?
  • Immobility
  • Improper Diet
  • Endocrine Metabolic Disorders
  • Neurological Disorders
  • Psychological Conditions
  • Structural Abnormalities
  • Medications

6
Some medications associated with constipation
  • Aluminium and calcium containing antacids
  • Anticholinergic agents
  • Calcium supplements
  • Antipsychotics
  • Iron
  • Opioids

7
.

Reference Australian Journal of Hospital
Pharmacy, 1998
8
1. Exercise - Fibre in the diet - Fluid Intake
  • No evidence that increased exercise is
    beneficial in severe constipation
  • Aim for 25-30g fibre/day
  • Unless dehydrated, increasing fluid does not
    relieve chronic constipation and may increase
    the risk of fluid overload eg heart or renal
    failure

9
The kitchen can help!
  • Add dry, fresh or canned fruit to cereal
  • Add legumes to soups casseroles
  • Include grated vegetables in rissoles, soups
  • Choose fruit desserts
  • Use high fibre snacks, raisin bread,
    date scones, carrot, muffins

10
2. Bulk Forming Laxatives
  • eg psyllium (Metamucil), sterculia
    (Normacol), ispaghula (Fybogel)
  • Improve stool consistency and frequency with
    regular use
  • Ensure good fluid intake to prevent faecal
    impaction
  • Onset of action 2-3 days
  • Side Effects may include bloating, flatulence,
    distension

11
3. Stool Softeners Lubricants
  • eg docusate (Coloxyl), paraffin oil (Agarol)
  • Efficacy of docusate is controversial
  • May be useful with anal fissures of
    haemorrhoids or when straining is a hazard
  • Liquid paraffin is not recommended for
    treatment of constipation
  • - risk of aspiration and lipid pneumonia
  • - long term use may result in depletion of
    Vitamins A, D, E and K

12
4. Osmotic Laxatives
  • Lactulose (Duphalac), Sorbitol (Sorbilax), PEG
    products (Movicol)
  • Lactulose/Sorbitol
  • - equally effective at improving stool
    frequency
  • - onset of action up to 48 hours
  • - metabolised by bacteria ? flatulence
  • Movicol - improves stool frequency and
    consistency - iso-osmotic and
    therefore water and electrolyte loss is
    limited

13
Some precautions with osmotic laxatives
  • Lactulose contains absorbable sugars and may
    adversely affect glycamic control in diabetics
  • Overuse may result in dehydration
  • Monitor for any signs of electrolyte
    disturbances
  • - oedema,
  • - shortness of breath,
  • - increasing fatigue,
  • - cardiac failure

14
Movicol and Thickeners
  • IMPORTANT Thicken the water as per the
    manufacturers instructions BEFORE adding Movicol

1. Mix the required amount of thickened water.
For convenience, this can be made ahead of time
and stored in the refrigerator for up to 48
hours. 2. To prepare Movicol for administration,
spoon about ¼ cup thickened water into a glass
and add Movicol powder. Stir thoroughly with a
spoon. 3. When mixed, add more thickened water to
make up to ½ cup (125mL) and again stir
thoroughly. 4. The mixture will return to the
required thickened state within approximately one
minute.
15
5. Stimulant Laxatives
  • Senna (Senokot), bisacodyl (Durolax, Bisalax)
  • Increase intestinal motility by stimulating
    colonic nerves
  • Useful with opioids
  • Onset of action 8-12 hours
  • Development of tolerance is reported to be
    uncommon
  • Generally considered 2nd line therapy in
    elderly due to risk of electrolyte disturbances
  • Other adverse effects include cramping,
    diarrhoea, dehydration

16
Nulax - the all natural and all organic in
origin fruit laxative
BEWARE
  • Is not formulated in a manner that ensures even
    distribution of the active ingredient ?
    inconsistent dosing
  • Contains senna leaf powder 400mg/5g dose 24mg
    sennosides/5g dose.
  • Senokot tablets contain 7.5mg sennosides/tablet

17
6. Enemas Suppositories
  • Used when rapid relief from faecal loading is
    required
  • Induce bowel movements by distension of the
    rectum and colon
  • Frequent use may cause poor rectal tone and may
    exacerbate incontinence
  • Tap water enemas are safest for regular use
  • Phosphate enemas (Fleet) increase the risk of
    hyperphosphataemia in renal impairment
  • Glycerine suppositories stimulate rectal
    secretion by osmotic action

18
Helping to prevent constipation
  • Patient education
  • Diet and Fluid Intake
  • Exercise
  • Effective Bowel Habits
  • Toileting Facilities
  • Medication Review
  • Ensure a laxative is prescribed with opioids
  • Imaginative ways to increase fibre-
  • Add dry, fresh or canned fruit to cereal
  • Add legumes to soups and casseroles
  • Include grated vegetables in rissoles soups
  • Choose fruit desserts
  • High fibre snacks eg raisin bread, date scones,
    carrot muffins
  • An Effective Fibre Supplement
  • 3 TBS unsweetened apple puree
  • 1 TBS unprocessed bran
  • 2-3 TBS prune juice
  • Add 1 TBS to breakfast cereal
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