Lynn Shaw

1
Lynn Shaw

• Colorectal Nurse Specialist

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Introduction

• Overlooked aspect of patient care
• Taboo subject
• Overuse of laxatives
• High financial cost to NHS

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Aims

• Define constipation its causes
• Discuss possible treatments

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What Is Constipation?

• Subjective symptom
• Traditionally defined as absence of bowel
  movement for several days or dry hard stools
• However individuals bowel habits vary widely

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What Is Constipation?

• Abnormally infrequent bowel movement
• Passing dry hard stools
• A sensation of incomplete evacuation

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Signs Symptoms

• Loss of urge
• Bloating
• Abdominal distension
• Pain
• Blood or mucus PR

• Coated tongue
• Bad taste in mouth
• Headache
• Nausea
• Malaise
• depression

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Classification

• Primary factors such as inadequate fluid or
  fibre intake
• Secondary disease or conditions
• Iatrogenic consequence of taking medication for
  other conditions

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Factors Affecting Constipation

• Habit
• Reduced fluid intake
• Poor diet
• Immobility

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Factors Affecting Constipation

• Social psychological factors
• Physical problems
• Medication
• Disease

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Habit

• Resisting urge to defaecate
• Busy lifestyles

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Reduced Fluid Intake

• Due to illness
• Renal conditions
• Busy lifestyles

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Poor Diet

• Due to illness or surgery
• Change of diet
• Financial
• Anorexia or bulimia

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Immobility

• Hospitalisation
• Illness
• Disease or debilitating conditions

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Social Psychological

• Depression
• Dementia
• Psychological conditions
• Learning disabilities
• Financial
• Loneliness
• Age

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Physical

• Rectal dysfunction
• Anorectal strictures
• Rectocele
• Uterine Prolapse
• Weak pelvic floor muscles
• surgery

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Medication

• Analgesics
• Antacids containing atropine or aluminium
• Antiemetics
• Diuretics
• Iron preparations

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Disease

• Anorectal fissures or prolapse
• Colorectal tumours
• Crohns disease or ulcerative colitis
• Diabetes
• Diverticular disease
• Haemorrhoids

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Disease

• Hypercalcaemia
• Hypopituitarism
• Hypothyroidism
• IBS
• MS
• Parkinson's disease

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Treatment

• Full patient assessment
• Exclusion of any serious medical condition
• Instigation of appropriate treatment

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Patient History

• Childhood
• Childbirth
• Past medical history
• Drug history
• Diet
• Bowel habit

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Investigations

• Digital rectal examination
• Abdominal x-ray
• Sigmoidoscopy
• Colonoscopy
• Barium enema
• Anorectal studies
• Transit studies

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Types of TreatmentNon Invasive

• Dietary advice
• Biofeedback
• Pelvic floor muscle exercises
• Correct positioning on the toilet

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Types of TreatmentInvasive

• Medication
• Enemas
• Suppositories
• Colonic/rectal irrigation

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Dietary

• High fibre diet including 5 portions of fruit
  veg daily
• Increase fluid intake recommended 1.5-2 litres
  daily dependant on patients height weight

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Biofeedback

• Combination of dietary, counselling and use of
  exercise regime specifically designed for each
  patient

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Pelvic Floor Muscle Exercises

• A regime of exercise specifically designed for
  each patient to tone the pelvic floor muscles and
  increase sphincter tone

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MedicationLaxatives

• Bulking agents
• Stimulant
• Osmotic
• Stool softening
• Lactulose
• Movicol

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Bulking Agents

• Natural bran
• Fybogel
• Ispaghula husk
• Normacol
• methylcellulose

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Stimulant Laxatives

• Senna
• Senokot
• Bisacodyl
• dulcolax

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Osmotic Laxatives

• Magnesium hydroxate
• Magnesium carbonate
• Magnesium sulphate

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Stool Softeners

• Co-Danthrusate
• Liquid paraffin
• Castor oil

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Lactulose

• Synthetic sugar metabolised by colonic bacteria
  to short chain organic acids that promote
  bacterial growth thus increasing faecal matter

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Movicol

• Polyethylene Glycol electrolytes
• Rehydrates the stool, making passage easier

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Enemas

• Phosphate
• Arachis oil
• microlax

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Suppositories

• Glycerine
• Bisacodyl

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Colonic/rectal Irrigation
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Conclusion

• Distressing problem
• Person specific
• Patient assessment vital
• Treatment tailored to individual
• Education