Mind Map by st20037616, updated more than 1 year ago
Created by st20037616 over 6 years ago


constipation - nice

Resource summary

  1. Classified as
    1. difficulty during defication /infrequent
      1. Hard/pain/straining
        1. may lead to bleading/rectal prolapse
      2. Causes
        1. Lack of Dietary Fib/fluid
          1. faecal impactation (dissabled/un mobile)
            1. certain meds (opoids:codine)
            2. prev better than cure!!!!
              1. pharm treatments - laxatives:
                1. 1st - Bulk forming (ensure ad water) :
                  1. fybogel
                    1. dont use buling agent with opoid induced constipation/use osmotic + stimulant
                      1. opioids block pain signals to brain - hence blocking the peristalsis msg that it stimulated with bulk forming laxitives
                        1. Enteric n. system
                          1. colonic nerves
                      2. A: Distend the colon=peristalsis
                      3. if soft but difficult to pass - Stimulant:
                        1. senna kot (metobilised into its active metabolite by bacterial enzymes in large bowl
                          1. A: inducing peristalsis
                          2. faecal softeners /DUCOSATE:
                            1. penut oil/ liquid parafin enema
                            2. 2nd - add to /switch to : osmotic :
                              1. lactalose
                                1. A: Retain water in stool
                                2. experts ad (NICE)- clear faecal impaction b4 treating chronic constp ; using step by step approach altering treatment to the patients needs
                                  1. Chronic Constp consideration - Laxatives
                                    1. hyd/bulking
                                      1. macrogols (osmotic effect)
                                        1. lacatalose
                                        2. stimulant
                                          1. Doses of above to be grad titrated up/down to produce / soft formed stools p/d (which can be assed on the bristol stool scale)
                                            1. if 2 or more lax comb have been trailed for 6mnts @ HIGHEST CONC
                                              1. MEN: LUBIPROSTONE
                                                1. WOMEN: PRUCLAOPRIDE
                                              2. oic
                                                1. lifestyle changes as with rest
                                                  1. avoid bulking lax/use osmotic ,stimulating
                                              3. Non Pharm
                                                1. inc exercise
                                                  1. in hydration
                                                    1. inc f/v
                                                      1. reg meal pattern
                                                        1. adjust any constipation meds if poss
                                                      2. Primary (no known cause)
                                                        1. secondary (meds/cond)
                                                          1. Red Flag
                                                            1. unintended weight loss
                                                              1. blood in stool
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