medicnotes.org.uk :: Constipation

Constipation

Causes of constipation:

Simple (low fibre diet)

Intestinal obstruction

Colonic disease (e.g. carcinoma)

Painful anal conditions (e.g. fissure)

Drugs (many!):

Opiates

Aluminium antacids

Antidepressants

Codeine

Iron

Hypothyroidism

Hypercalcaemia

Depression

Immobility

Hirschsprung’s disease

Treatment:

Laxatives should be avoided if at all possible

Encourage the patient to eat a high-fibre diet

Glycerol suppositories (which can be used by the patient) are often useful

The types of laxatives available are shown below. Bulking agent should be tried first.

Stimulant laxatives often cause cramp and their long-term use should be avoided as they cause an atonic, non-functioning colon

Magnesium is very useful in severe constipation

Laxatives:

Bulking agents:

Dietary fibre

Bran

Ispaghula husks

Sterculia

Methylcellulose

Stimulant laxatives:

Anthraquinones (e.g. Senna)

Dioctyl sodium sulphosuccinate

Danthron (for the elderly or for opiate-induced constipation in the terminally ill)

Bisacodyl

Osmotic laxatives:

Magnesium (sulphate or hydroxide)

Lactulose

Suppositories:

Bisacodyl

Glycerol

Constipation

Enemas:

Phosphate

Sodium citrate


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	Constipation Causes of constipation: Simple (low fibre diet) Intestinal obstruction Colonic disease (e.g. carcinoma) Painful anal conditions (e.g. fissure) Drugs (many!): Opiates Aluminium antacids Antidepressants Codeine Iron Hypothyroidism Hypercalcaemia Depression Immobility Hirschsprung’s disease Treatment: Laxatives should be avoided if at all possible Encourage the patient to eat a high-fibre diet Glycerol suppositories (which can be used by the patient) are often useful The types of laxatives available are shown below. Bulking agent should be tried first. Stimulant laxatives often cause cramp and their long-term use should be avoided as they cause an atonic, non-functioning colon Magnesium is very useful in severe constipation Laxatives: Bulking agents: Dietary fibre Bran Ispaghula husks Sterculia Methylcellulose Stimulant laxatives: Anthraquinones (e.g. Senna) Dioctyl sodium sulphosuccinate Danthron (for the elderly or for opiate-induced constipation in the terminally ill) Bisacodyl Osmotic laxatives: Magnesium (sulphate or hydroxide) Lactulose Suppositories: Bisacodyl Glycerol Constipation Enemas: Phosphate Sodium citrate
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