Bikash Kumar Sah 2 Semester Pucmas

CONSTIPATION
Bikash Kumar Sah

2nd Semester
PUCMAS
TOILET TROUBLES
 Constipation affects more than 4.5 million

Canadians!
 Constipation affects twice as many women as
men
WHAT IS CONSTIPATION?
 Constipation is generally defined as infrequent and/or
unsatisfactory defecation fewer than 3 times per
week.
 Patients may define constipation as passing hard
stools or straining, incomplete or painful defecation.
 Constipation is a symptom,
NOT a disease.
 Constipation has many causes
and may be a sign of undiagnosed
disease.
RISK FACTORS FOR CONSTIPATION
 The following factors can increase a person’s
likelihood of becoming constipated; however, these
do not need to be present for constipation to occur:
 Female gender
 Over 65 years of age
 Low caloric intake (eating less food)
 Greater number of medications used
 Sedentary lifestyle (lack of exercise)
 Ignoring the urge to defecate
CAUSES OF CONSTIPATION
 Diet
 Lack of exercise
 Age
 Nerves, stress
 Ignoring the urge
 Drug induced – pain medications, iron, calcium, blood
pressure medications, etc
 Disease States/Conditions – Multiple Sclerosis,
hypothyroidism, hemorrhoids, Parkinson’s, senility, Irritable
Bowel Syndrome, pregnancy, diabetic neuropathy, etc.
SIGNS AND SYMPTOMS OF CONSTIPATION
 Infrequent defecation
 Nausea
 Vomiting
 Anorexia
 Feeling full quickly
 Stools that are small, hard, and/or difficult to evacuate
 Rectal bleeding
 Weight loss (in chronic constipation)
WHEN SHOULD I CONTACT A HEALTH CARE PROVIDER?
• Constipation for more than 2 weeks (or • Vomiting

has not had a bowel movement for • Severe pain upon defecation
more than 7 days) despite use of • Diarrhea alternating with constipation
laxatives; particularly in elderly and in • Recent abdominal surgery
those with chronic medical conditions
such as diabetes or parkinson’s disease
• Eating disorders
• If medication is suspected to be the
• Moderate to extreme thirst
cause of constipation • Unexplained weight loss of greater than
• Blood or mucus in stool or rectal 5%
bleeding, fever • Chronic illness associated with
• Symptoms suggestive of anemia such constipation
as tiredness or lethargy • Rectal or abdominal mass
• Family history of colon cancer
(particularly if patient is >50 years old)
• Persistent abdominal pain
PREVENTION OF CONSTIPATION
• High fibre diet
• Minimum fluid consumption of 1500mL daily
• Regular, private toilet routine
• Heed the urge to defecate
• Use of a laxative if using constipating medication or
in presence of diseases associated with constipation
I’M CONSTIPATED, NOW WHAT?
 Two approaches to consider:
 Non-drug Approach
 Drug Approach
 Non-Drug Measures:
 Increase calories in low calorie diets

 Have a regular bowel regimen: patients should attempt to have a bowel
movement at the same time each day especially after breakfast since colonic
activity is highest at that time. Patients should not repress the urge to defecate
or spend prolonged periods of time at the toilet. Placing a footstool in front of
the toilet helps elevate the thighs, thus placing the pelvis in the optimum
position for defecation.
 Consume a high fibre diet: the target is 25-28g of fibre daily
 Eat more fruits: apples, pears, and prunes contain the natural laxative sorbitol
 Exercise: inactivity is associated with constipation
 Weight loss: want BMI to be between 18.5-24.9
 Drug Measures:
 There are many different types of drugs that can be used for
constipation:
 Bulk-forming Agents
 Emollients/Stool Softeners
 Osmotics
 Hyper-osmotics
 Stimulants
 Bulk-Forming Agents:
 Examples: Metamucil, Benefiber, FiberSure
 Are considered the safest agents and are suitable for long-term use
 Each dose of a bulk-forming laxative should be administered with
a full glass of water or juice
 Do not use if patient is dehydrated or fluid restricted
 Are the drug of choice for prevention; not for immediate relief
 Emollients/Stool Softeners
 Example: Docusate
 Used for prevention; not for immediate relief
 Used very often but lack of data showing it actually works
 Company says that this product “makes it easier to go”
 Osmotics:
 Examples: Milk of Magnesia
 Limitations for use of this group of laxatives include frequent
diarrhea, and multiple electrolyte abnormalities.
 Should be administered with sufficient water to prevent
dehydration.
 Not used very often
 Hyper-Osmotics:
 Examples: Glycerin Suppositories, Lactulose Syrup, Lax-a-Day
(PEG 3350)
 PEG produces the loosest stool and overall greatest efficacy
compared to other members in this class. It may have benefit in
patients unresponsive to other treatments. Daily use of PEG is safe
and does not have significant side effects and may facilitate the
discontinuation of other laxatives. May take 2-4 days to see an
effect. This is the drug of choice in almost all situations!
 Lactulose is very safe to use long term. May see increase in gas
and bloating compared to other options. Takes 1-2 days to work.
 Glycerin suppositories have a quicker onset of action (usually 30-
60 minutes). They are less effective if the stool is dry and hard.
 Stimulants:
 Examples: Senokot, Dulcolax (bisacodyl)
 This group produces rhythmic muscle contractions in the intestines
and may be recommended if osmotic laxatives fail or are not
tolerated.
 Are usually given at bedtime and they usually provide overnight
relief (work within 8-12 hours).
SPECIAL CONSIDERATIONS IN THE ELDERLY
 Treatment is often complicated by chronic conditions, multiple drug use, and

cognitive impairment.
 Management should be tailored to each individuals needs and expectations
regardless of age or place of residence.
 The patients functional abilities related to mobility, following instructions,
communicating needs, eating, drinking, and cognitive status must be assessed.
 Fluid intake should target 1500-2000mL daily unless fluid restrictions are imposed
as in those with heart failure.
 Dietary fibre should be targeted at 25-30g daily.
 Exercise to patients capacity.
 Drug review is essential to rule out drug induced constipation.
 Renal impairment must be monitored prior to using laxatives.
 Don’t use laxatives for more than a week unless the doctor says it is ok.
 Safest laxative to use is a bulk forming agent such as Metamucil.
SPECIAL CONSIDERATIONS IN NURSING HOME
RESIDENTS
 Many nursing homes have “bowel programs” for
their residents. These include exercise, increasing
the amount of fibre in the meals, and bowel
retraining.
 Oral agents are commonly used:
 Senokot is common for quicker relief
 Lax-a-Day or Metamucil very common for prevention
 Lactulose is very useful for people who are bedridden
SUMMARY
 Constipation is very common in the elderly and nursing
home residents.
 There are many causes of constipation; it should be
considered a symptom, not a disease.
 There are many options for prevention and treatment.
The choice should be tailored to each individual person.
 Talk to your health care provider if you have any
concerns or if constipation lasts for longer than one
week.
THANK-YOU

Bikash Kumar Sah 2 Semester Pucmas

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CONSTIPATION

Bikash Kumar Sah

 Constipation affects more than 4.5 million

• Constipation for more than 2 weeks (or • Vomiting

 Two approaches to consider:

 Increase calories in low calorie diets

 Treatment is often complicated by chronic conditions, multiple drug use, and

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