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Constipation

Constipation . Prepared by : Safaa raed Baraa maher. Definition . Constipation is defined as a decrease in the frequency of fecal elimination and is characterized by the passage of hard, dry , and sometimes painful stools .

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Constipation

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  1. Constipation Prepared by : Safaaraed Baraamaher

  2. Definition • Constipation is defined as a decrease in the frequency of fecal elimination and is characterized by the passage of hard, dry , and sometimes painful stools . • Patients may experience abdominal bloating , headaches , low back pain .

  3. Epidemiology • age > 65 years • Women suffer from constipation more than men .

  4. Causes • Diet (a) insufficient dietary fiber. (b) inadequate fluid intake. • Lack of exercise . • Medication e.g ( anticholinergics ) • Pregnancy

  5. Pharmacist should question the patient about the following • Normal stool frequency . • Duration of the constipation . • Frequency of constipation episodes. • Exercise routine. • Amount of dietry fiber consumed and fluid intake. • Presence of other symptoms • Current medication • Medications used to relive constipation and their effectiveness.

  6. Treatment • Non pharmacological : • Increase intake of fluids . • Increase exercise to increase and maintain bowel tone . • Bowel training to increase regularity.

  7. Pharmacological : • Bulk forming laxatives natural or synthetic polysaccharide derivatives that adsorb water to soften the stool and increase bulk which stimulates peristalsis . It acts in both the small and the large intestines. • Natural pysllium , Malt soup extract. • Synthetic methylcellulose,polycarbophil.

  8. Adverse effects : abdominal cramping, flatulence . • Administration guidelines : • Should not be used if patients have an obstructing bowel lesion . • Some bulk forming medications may contain sugar , so patients with diabtes should use sugar free products. • Should not use for more than 1 week to treat constipation .

  9. saline and osmotic laxatives work by creating an osmotic gradient to pull water into the small and large intestines . This increased volume results in distention of the intestinal lumen , causing increased peristalsis and bowel motility. • Saline laxatives sodium and magnesium salts . • Osmotic laxatives glycerin, lactulose, sorbitol, polyethlene glycol.

  10. Adverse effects : diarrhea , abdominal pain . • Administration guidelines : • Patient should consume 8 oz. of water to prevent possible dehydration . • Patient with HTN or CHF should not receive saline laxatives owing to fluid retention from sodium absorption . • Patients with sever kidney disease should not use products containing magnesium .

  11. Stimulant laxatives work in the small intestines to stimulate bowel motility and increase the secretion of fluids into the bowel. • Includes : • Anthraquinone laxatives senna . • Diphenylmethane derivative Bisacodyl . • Castor oil . • Adverse effects : abdominal cramping , fluid and electrolyte deficienes.

  12. Administration guidelines • Patients with signs of intestinal obstruction should not use stimulant laxatives. • Possible carcinogenicity of stimulant laxatives. • Chronic use lead to cathartic colon , which results in a poorly functioning colon and resembles the symptoms of ulcerative colitis .

  13. Emollient laxatives act as surfactant by allowing absorption of water into the stool which makes the softened stool easier to pass. • Adverse effects : diarrhea .

  14. Lubricant laxative increase water retention in the stool to soften the stool . • Adverse effect : perianal discomfort . • Administration guidelines : • Should be taken on empty stomach . • Should not be given to children < 6 years. • Should not be given to patients with rectal bleeding or appendicitis.

  15. Special patient issues • Pediatric patients during the first weeks of life,infants pass approximately 4 stools /day. • As get older, approximately 1-3 stools are passed per day . • Treatment : increasing the amount of fluid or sugar in a child's formula , glycerin suppositories and magnesium laxatives, enemas should not be used in children <2 years .

  16. Pregnant patients constipation is common and is often the result of compression of the colon by the enlarged uterus. • Pregnant patients should use bulk forming agents or stool softeners . • Geriatric patients at risk for constipation because of insufficient fiber and fluid intake , failure to establish a regular bowel time habit and abuse of stimulant laxatives .

  17. Glycerin suppositories or orally administered lactulose may be useful for initial treatment of constipation and bulk forming agents used to prevent constipation .

  18. Some medications in the market

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