Constipation

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All you need to know about "Constipation"
- Causes, treatment and protection.

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Constipation

  1. 1. Faculty of Pharmacy - Alexandria University (Egypt)
  2. 2. Question №. 11. I am 30 years old and my stool Frequency decreased from three times per day to once every two days: Am I constipated? What are the major symptoms of constipation? Faculty of Pharmacy - Alexandria University (Egypt)
  3. 3. What is Constipation? Decrease in the frequency in of fecal elimination. Passage of hard, dry, sometimes painful stool.Normal Range From 3 times daily to 3 times per week. * So the patient is not constipated Faculty of Pharmacy - Alexandria University (Egypt)
  4. 4. Etiology Patient Counseling Life Style causes of constipation:1. Diet: a) Inadequate fluid intake Should drink at least 8 glasses of non-caffeinated fluids daily. Faculty of Pharmacy - Alexandria University (Egypt)
  5. 5. Etiology Patient Counselingb) Inadequate dietary fibers Diets include a good quantity of fibers are less likely to suffer from constipation. Fiber retains water, softening stool & ease evacuation. Foods low in fiber  high fat food. Foods rich in fiber  fruits, veg. and whole grain. Normal daily fiber intake 10 ̴ 25 g.■ Faculty of Pharmacy - Alexandria University (Egypt)
  6. 6. Etiology Patient Counselingc) Inadequate exercises Walking help prevent constipation by promoting bowel motility.d) Loss of defecatory reflex If you ignore the urge to have a bowel movement. The urge can gradually go away. The longer can you delay it, the drier and harder stool will become. Faculty of Pharmacy - Alexandria University (Egypt)
  7. 7. Headache Sense of rectal Symptoms of Abdominal bloatingfullness constipation Low back pain Faculty of Pharmacy - Alexandria University (Egypt)
  8. 8. Question №. 21. My grandmother usually feels discomfort from chronic constipation: What are reasons for this problem? What are your advice? Faculty of Pharmacy - Alexandria University (Egypt)
  9. 9. Epidemiology Risk factors of constipation Age Gender• Constipation is common in • Females are three times more elderly people ( > 65 y.) likely to suffer from constipation• Laxative abuse than males•  gut motility• Medication use• Poor nutrition Faculty of Pharmacy - Alexandria University (Egypt)
  10. 10. Your advice1. Laxative abuse:  Lead to cathartic colon (loss of tone of intestinal muscles) cause poor bowel function.2. Increase intake fluids & fibers.3. Increase exercise (  bowel tone). Faculty of Pharmacy - Alexandria University (Egypt)
  11. 11. Question №. 33. My wife is pregnant she is worried about constipation, I would like to know: What is the factors that predispose pregnant to constipation? Faculty of Pharmacy - Alexandria University (Egypt)
  12. 12. Factors which constipate pregnant Progesterone • Bowel hypo-motility levelUterus compress • Slowing down the passage the intestine of food Less exercise • Reduce bowel activityVitamins intake • Can be constipated (Fe2+ , Ca2+ ) Faculty of Pharmacy - Alexandria University (Egypt)
  13. 13. Question №. 44. Is there a relationship between anal disorders as abscesses and constipation? Faculty of Pharmacy - Alexandria University (Egypt)
  14. 14. Abscess It is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue. Usually caused by bacteria or parasites infection. Faculty of Pharmacy - Alexandria University (Egypt)
  15. 15. Perianal abscesses • Passage of hard stool Found in patients with inflammatory 1 • Cause an internal wound bowel disease (Crohns disease) or the rectal • The wound infected because of presence of feces in diabetes. 2 area. • Abscess is developed 3 • It presents as a lump of tissue near the anus 4 • By the time, it becomes larger and more painful 5 Faculty of Pharmacy - Alexandria University (Egypt)
  16. 16. Question №. 55. I heard that there is a medical condition called “Colonic inertia”: What is it? How diet can affect colonic motility? Faculty of Pharmacy - Alexandria University (Egypt)
  17. 17. Colonic Inertia Prolonged colon transit time• The average time of passage through the GIT is 4 days.  Colonic dysfunction  Prolong colon transit of the fecal polus  More water absorption  Increase in its hardness Faculty of Pharmacy - Alexandria University (Egypt)
  18. 18. Diet & Colonic motility Motility may be stimulated by boosting carbohydrates intake while limiting protein. Faculty of Pharmacy - Alexandria University (Egypt)
  19. 19. Question №. 66. Is it true that some health problems may lead to constipation? Explain your answer. Faculty of Pharmacy - Alexandria University (Egypt)
  20. 20. Pain During defecation  avoidance  constipation.Causes 1. Passage of hard stool. 2. Anal fissures and abscess. 3. Hemorrhoids. Faculty of Pharmacy - Alexandria University (Egypt)
  21. 21. Health problems may lead to constipation1. Carcinoma2. Irritable bowel syndrome (IBS) common cause in younger people3. Diabetes 60% of diabetics patient4. Renal failure due to electrolyte & fluid disturbance Faculty of Pharmacy - Alexandria University (Egypt)
  22. 22. Health problems may lead to constipation5. Parkinsonism up normal gut motility & rigid muscles6. Colonic inertia7. Pregnancy Faculty of Pharmacy - Alexandria University (Egypt)
  23. 23. Question №. 77. I am taking Hæma-Caps for anemia: ® Is that related to constipation I am suffering these days? What are the others drugs that can cause constipation? Faculty of Pharmacy - Alexandria University (Egypt)
  24. 24. Iron vs. Constipation Iron slow down the digestive system & slowing of normal bowel movement. This may be because iron is a metal in its basic form. Metals carry a charge that can affecting muscles and nerves in the bowel Faculty of Pharmacy - Alexandria University (Egypt)
  25. 25. Drugs cause constipation1. Narcotic analgesics2. Diuretics3. Anticonvulsants4. Sympathomimetics or anticholinergic5. Antihistaminic6. Antacids (containing Ca2+,Al3+) Faculty of Pharmacy - Alexandria University (Egypt)
  26. 26. Question №. 88. My brother suffers from chronic constipation. ® He starts taking Purgaton tablets on regular basis. First the condition improved but now the case is worse. What do you think? Faculty of Pharmacy - Alexandria University (Egypt)
  27. 27. ® Purgaton tablet Contain senna glycosides (anthraquinone) With extended use cause lazy bowel syndrome (atonic colon) Bowel unable to move without chemical stimulation.■ Faculty of Pharmacy - Alexandria University (Egypt)
  28. 28. Question №. 9 My mother suffers from abdominal discomfort as a result of constipation but she refuses taking laxatives. Could you tell me the appropriate life style modifications for her to follow ? Faculty of Pharmacy - Alexandria University (Egypt)
  29. 29. Life style modifications increased intake of water, and fiber (either dietary or as supplements). The routine use of laxatives is discouraged, as having bowel movements may come to be dependent upon their use. Faculty of Pharmacy - Alexandria University (Egypt)
  30. 30. Life style modifications Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract. Faculty of Pharmacy - Alexandria University (Egypt)
  31. 31. Question №. 10 Constipation may be a sign for many serious health problems . Is that true? Explain Faculty of Pharmacy - Alexandria University (Egypt)
  32. 32. General precautions Faculty of Pharmacy - Alexandria University (Egypt)
  33. 33. Question №. 11 I have constipation and want to know the different classes of drugs that I can use for treatment? Faculty of Pharmacy - Alexandria University (Egypt)
  34. 34. Types of laxative1. Bulk laxative Natural or synthetic polysaccharide derivatives that absorb water to soften stool. Slow onset of action (12-24 hr). E.g. Psyllium & malt soup extract (natural) Methyl cellulose (Synthetic) Faculty of Pharmacy - Alexandria University (Egypt)
  35. 35. Types of laxative1. Bulk laxative Shouldnt used with patient have an obstructing bowel legion. Used for protection from constipation. Used for pregnant. Faculty of Pharmacy - Alexandria University (Egypt)
  36. 36. Types of laxative2. Stimulant laxative Work on small and large intestine to simulate bowel motility. Onset of action 6-12 hr orally Shouldn’t used more than 1 week. Should avoid in pregnancy Faculty of Pharmacy - Alexandria University (Egypt)
  37. 37. Types of laxative2. Stimulant laxative E.g. Senna glycoside (Anthraquinone) Castor oil  Strong cathartic effect  Lead to dehydration Faculty of Pharmacy - Alexandria University (Egypt)
  38. 38. Types of laxativeBisacodyl  Diphenyl derivative  Enteric coated  Avoided with H2 blocker Faculty of Pharmacy - Alexandria University (Egypt)
  39. 39. Types of laxative3. Emollient laxative Stool softeners Slow onset 24 – 72 hr. Used for prevention than treatment. Faculty of Pharmacy - Alexandria University (Egypt)
  40. 40. Types of laxative4. Lubricant laxatives Mineral oil (as liquid paraffin) Increase water retention in colon Onset 6 – 8 hr orally 5 – 15 min rectally Cause anal seepage results in etching Decrease absorption of fat-soluble vit. Faculty of Pharmacy - Alexandria University (Egypt)
  41. 41. Types of laxative4. Lubricant laxatives Should take on empty stomach Shouldn’t take at bed time Shouldn’t given to children < 6 years Faculty of Pharmacy - Alexandria University (Egypt)
  42. 42. Question №. 12 My wife is pregnant and she is complaining of constipation . If you dont mind recommend her the appropriate medication illustrating how it works. And how to use it properly ? Faculty of Pharmacy - Alexandria University (Egypt)
  43. 43. Bulk forming laxative Natural or synthetic polysaccharide derivative that absorb H2O to soften the stool and increase bulk. Onset of action of these agents is slow (12-24 hr and up to hr), which is why they are the best used to prevent constipation rather than to treat severe acute constipation. Faculty of Pharmacy - Alexandria University (Egypt)
  44. 44. How to use?Faculty of Pharmacy - Alexandria University (Egypt)
  45. 45. Question №. 13 My grandmother is constipated but cannot swallow oral tablets. What other dosage form are available? Faculty of Pharmacy - Alexandria University (Egypt)
  46. 46. Dosage form Syrup as Duphalac® Suppositories as Glycerin ®, Bisadyl ® Oral drops as Picolax ® Enema as Enemax ® ■ Faculty of Pharmacy - Alexandria University (Egypt)
  47. 47. Faculty of Pharmacy - Alexandria University (Egypt)
  48. 48. Question №. 14 My grandfather is taking many medication for his CHF and rheumatic pain but the condition is not improving also can he takes Regumucil® sachets and Epsom salt for constipation? Faculty of Pharmacy - Alexandria University (Egypt)
  49. 49. Answer Dose spacing is essential with digitalis for (CHF) and salicylates as the laxative may reduce the effectiveness of the medication. Faculty of Pharmacy - Alexandria University (Egypt)
  50. 50. Question №. 15 My baby is usually straining during defecation. What is the best OTC medication for his condition? Faculty of Pharmacy - Alexandria University (Egypt)
  51. 51. Answer The first question to ask: Is my child really constipated if he is constipated so glycerin pediatric suppositories is considered. Faculty of Pharmacy - Alexandria University (Egypt)
  52. 52. Question №. 16 My friend suggest me enemas as rapid treatment for constipation, what do they contain? and what they advantage? Faculty of Pharmacy - Alexandria University (Egypt)
  53. 53. Enemas Di-Na Phosphate and Mono-Na Ph. They are highly hygroscopic and water soluble. Faculty of Pharmacy - Alexandria University (Egypt)
  54. 54. Advantages Rapid & effortless evacuation of the bowelUsed in cases of:1. Cardiac patients2. Glaucoma3. Ophthalmic surgery4. Post operative Faculty of Pharmacy - Alexandria University (Egypt)
  55. 55. Question №. 17My grandfather suffer from hepatic encephalopathy, isthere is any laxative that can help in his condition ?What are the precaution concerning its use?(Counseling and interactions) Faculty of Pharmacy - Alexandria University (Egypt)
  56. 56. A) Is there is any laxative that can help inhis condition? Lactulose®1. Duphalak syrup.2. Lactulose syrup. Faculty of Pharmacy - Alexandria University (Egypt)
  57. 57. B) What are the precautions concerning its use? (Counseling and interactions)1-It may take from (1-3)days to act so useful in treatment of chronic constipation in adults2-It shouldn’t be taken concomitantly with locally acting aminoglycoside antibiotics.3-It should be taken with fruit juice, water or milk to increase its palatability. Faculty of Pharmacy - Alexandria University (Egypt)
  58. 58. Question №. 18My brother abuse taking Mucinum cascara®tablets for constipation,what is your advice?A: Mucinum cascara® tablets shouldn’t be used for more than 1 week.B: Chronic use of this stimulant laxative leads to cathartic colon resulting in a poorly functioning colon . Faculty of Pharmacy - Alexandria University (Egypt)
  59. 59. C: It may show the symptoms of ulcerative colitis.Also, it may discolor the urine with pink to red orbrown to black. Faculty of Pharmacy - Alexandria University (Egypt)
  60. 60. Question №. 19 Abilaxine® tab are effective in reliving constipation . Comment on their administration immediately after meals or with Epicogel® suspension. Faculty of Pharmacy - Alexandria University (Egypt)
  61. 61. Bisacodyl Abilaxine ® is containing Bisacodyl formed as an enteric coated tablet . All biscodyl containing product shouldnt be taken within an hour of ingesting food or antacid (as epicogel) or milk. Should be avoided in patient tacking H2 blocker. Faculty of Pharmacy - Alexandria University (Egypt)
  62. 62. Question №. 20My sister is pregnant; can she take castor oilor Minalax® tablets for constipation?What is docusate?Mention its medicinal syndromes. Can she take castor oil or Minalax® tablets for constipation? No she cannot take castor oil because of its danger Faculty of Pharmacy - Alexandria University (Egypt)
  63. 63. What is the danger of Castor oil in this case?1. Premature labor due to premature uterine contractions.2. Death due to amniotic air embolism.3. Impaired health of the infant. Faculty of Pharmacy - Alexandria University (Egypt)
  64. 64. But, she can take Minalax tablets because :-1- It is emollient laxative (stool softener) which is safe.2- It acts as surfactant by allowing absorption of water into the stool so;It makes the softened stool easier to pass. Faculty of Pharmacy - Alexandria University (Egypt)
  65. 65. B) What is docusate?1. It is emollient laxative (stool softener).2. They act as surfactant by allowing absorption of water into the stool so; it makes the softened stool easier to pass). Faculty of Pharmacy - Alexandria University (Egypt)
  66. 66. C) Mention its medicinal syndromes?1. For patients who must avoid straining to pass hard stools. as those recently have a myocardial infarction or rectal surgery.2. Safe for pregnant. Faculty of Pharmacy - Alexandria University (Egypt)
  67. 67. Question №. 21I prefer taking paraffin as laxative.What is your advice?How about using it concomitantlywith Minalax® tablets in severeconstipation? Faculty of Pharmacy - Alexandria University (Egypt)
  68. 68. A:- My advice:-1. It should be taken on an empty stomach. (Because of its possible aspiration into the lungs, lipid pneumonitis may occur).2. Patients shouldn’t take it at bed time or recline after administration. Faculty of Pharmacy - Alexandria University (Egypt)
  69. 69. B) How about using it concomitantly withMinalax® tablets in severe constipation? Minalax® may increase the systemic absorption of paraffin leading to hepatotoxicity. Faculty of Pharmacy - Alexandria University (Egypt)
  70. 70. Question №. 22I am suffering from chronic constipation andusually strain during defecation. Can this lead tohemorrhoids? And are there are any other causes?(Define hemorrhoids and mention its etiology andepidemiology).A) Can this lead to hemorrhoids?- Yes, hemorrhoids will occur. Faculty of Pharmacy - Alexandria University (Egypt)
  71. 71. B) Define hemorrhoids  Hemorrhoids refers to a condition in which the veins around the anus or lower rectum are swollen, inflamed and abnormally large.  Simply, hemorrhoids represent downward displacement of anal cushions that contain arteriovenous anastomoses. Faculty of Pharmacy - Alexandria University (Egypt)
  72. 72. B. Etiology1- Hereditary.2-Acquired factors: Straining during defecation push the hemorrhoid veins downward with increased venous pressure, they dilate and become engorged. Faculty of Pharmacy - Alexandria University (Egypt)
  73. 73.  Over time the fibers that anchor the hemorrhoidal veins to their underlying muscular coats stretch which result in prolapsed. Occupations that require heavy lifting can transform asymptomatic hemorrhoids into a problem. Faculty of Pharmacy - Alexandria University (Egypt)
  74. 74. C) Epidemiology The risk of developing hemorrhoids increases with advanced age and pregnancy.■ Faculty of Pharmacy - Alexandria University (Egypt)
  75. 75. Faculty of Pharmacy - Alexandria University (Egypt)
  76. 76. • Is a condition in which the veins around the anus or lower rectum are swollen and inflamed• Risk of developing hemorrhoid increase with advanced age and pregnancy.• It may internal or external or mixed.
  77. 77. Question №. 23 I am feeling discomfort in the anal area, a friend suggested I am suffering from Hemorrhoids; I want to know if my symptoms can be caused by any other condition and what are the other symptoms of hemorrhoids? Faculty of Pharmacy - Alexandria University (Egypt)
  78. 78. Other conditions1. A similar knife-like pain can be caused by herpes simplex virus.2. aching discomfort made worse by defecation could be due to piles.3. A throbbing pain, worsening over a few days, and bad enough to disturb your sleep. Faculty of Pharmacy - Alexandria University (Egypt)
  79. 79. Other conditions1. An occasional, severe, cramp-like pain deep in the anal canal.2. A continuous aching pain in the anus needs to be sorted out by your doctor.. Faculty of Pharmacy - Alexandria University (Egypt)
  80. 80. Symptoms of Hemorrhoid Bleeding during bowel movements, itching, and rectal pain are the most common hemorrhoid symptoms.1. Internal hemorrhoids Rectal bleeding, Itching , skin irritation and pain.2. External hemorrhoids Rectal pain occurs mainly. Blood may pool under the skin, forming a hard, painful lump. This is called a thrombosed, or clotted. Faculty of Pharmacy - Alexandria University (Egypt)
  81. 81. Question №. 24 I know that hemorrhoids can be classified into different types.  Please tell me these types and how each type is treated? Faculty of Pharmacy - Alexandria University (Egypt)
  82. 82. 1. External Hemorrhoids occurs outside of the anal canal. very painful It’s very common for these type of hemorrhoids to bleed. Blood can often be found on the stool or toilet paper. Faculty of Pharmacy - Alexandria University (Egypt)
  83. 83. 2. Internal Hemorrhoids Occur inside the anal canal. Internal hemorrhoids don’t usually cause as much pain as external. Internal hemorrhoids come about when there is too much pressure on the veins inside the anal canal. Faculty of Pharmacy - Alexandria University (Egypt)
  84. 84. Other classification1. First degree : painless bleeding is present2. Second degree : descend with defecation but returns spontaneously with relaxation.3. Third degree : requires manual replacement into rectum after prolapse. pain ,bleeding are present4. Fourth degree : cant be manipulated manually . thrombosis often occur Faculty of Pharmacy - Alexandria University (Egypt)
  85. 85. Treatment For external hemorrhoids which are still not bleeding and have not yet thrombosed, this could be treated with a hemorrhoid cream, ointment, warm baths, witch hazel. Mild internal hemorrhoids could also be cured with suppositories of hemorrhoid cream, witch hazel, and possibly by using a supplement. Faculty of Pharmacy - Alexandria University (Egypt)
  86. 86. Treatment when your hemorrhoids have thrombosed, prolapsed more intensive treatment may be recommended. Some of the options include hemorrhoid surgery, and laser coagulation. Higher degree of internal hemorrhoids: Hemorrhoid banding  is a procedure in which the physician puts a tight band around the hemorrhoid to control bleeding Faculty of Pharmacy - Alexandria University (Egypt)
  87. 87. Treatment Infrared photocoagulation: infrared light is focused at the base of hemorrhoids Sclerotherapy: injection of aseclerosing agent into the hemorrhoids Cryotherapy: freezing the hemorrhoids Faculty of Pharmacy - Alexandria University (Egypt)
  88. 88. Question №. 25My brother suffer hemorrhoid he relies on self treatment, but could you tell me when should he consult doctor? IF these products dont improve symptoms within seven days , if severe bleeding ,pain happen, if patient below 12 years old. So you should consult your doctors to seek the medical attention immediately Faculty of Pharmacy - Alexandria University (Egypt)
  89. 89. Question №. 26 There are many dosage forms available for relieving hemorrhoid what they also what is the best one? Ointment ,cream , suppositories, sprays but Cream ,oint., is superiors to suppositories, it may be bypass the affected area. Area must be washed by soap and dry before applied product. Faculty of Pharmacy - Alexandria University (Egypt)
  90. 90. Question №. 27 I heard that there are varieties of OTC drugs used for ttt of hemorrhoid what are the possible class they belongs to ?giving Ex from Egypt markets. Faculty of Pharmacy - Alexandria University (Egypt)
  91. 91. Trade name Dosage form Active ingredientAnusol Supp,ont Zno ,bisthmus subgallate balsam peru,bisthmus oxidebisthmus oxide, balsam perubisthmus subgallate: :is demulcentare astringent Faculty of Pharmacy - Alexandria University (Egypt)
  92. 92. Faktu® Supp,oint. Policresulen, cinchocainePolicresulen is Cinchocaine isatopical an amide localhaemostatic anestheticand antiseptic Faculty of Pharmacy - Alexandria University (Egypt)
  93. 93. Procto-4® Supp,cream Framycetine,es culin,hydrocorti sone, bisthmus oxideFramycetine: Esculin:is antibacterial vasoprotectiveto protect ,have capillaryagainst bacterial astengtheninginfection action Faculty of Pharmacy - Alexandria University (Egypt)
  94. 94. proctoglyvenol Supp,cream Tribenoids,lidoc aineTribenoids isvasoprotective Faculty of Pharmacy - Alexandria University (Egypt)
  95. 95. Question №. 28 My friend usually feel pain during defecation as he suffers from hemorrhoids he start to use Lignocaine® cream as pain relievers ,please tell me how to use it properly ? Faculty of Pharmacy - Alexandria University (Egypt)
  96. 96.  It is local anesthetics used for pain , itching ,burning in the perianal region or lower anal canal (not in rectum ) as no sensory pain receptors . Must not to be applied to abraded skin as this will increase absorption systemically. Not to be used for more than seven days. Faculty of Pharmacy - Alexandria University (Egypt)
  97. 97. Question №. 29 My brothers defecation bloody ,can he take H- formula cream for his condition ,what is the role of shark liver oil in this product? Faculty of Pharmacy - Alexandria University (Egypt)
  98. 98.  Yes, he can take it until he have normal blood pressure ,no cardiac problems ,no thyroid gland problems. As H-formula contain phenyl ephedrine which is vasoconstrictors. Faculty of Pharmacy - Alexandria University (Egypt)
  99. 99. Shark liver oil Shark liver oil is natural source of vitamin A which is promotes wound healing and tissues repair ,relieves symptoms accompanying . It act as emollient and protectant that provides physical barriers to irritation by forming protective layers over mucos membrane and anal region by preventing excessive water loss from tissue . Faculty of Pharmacy - Alexandria University (Egypt)
  100. 100. Question №. 30 I am suffering from sever irritation and inflammation in the preanal area which is the best form my condition . Anusol® , or Anusol-HC® Oint. ? Faculty of Pharmacy - Alexandria University (Egypt)
  101. 101.  Anusol-HC® is best . because it have hydrocortisone which ttt sever irritation and inflammation but it mask fungal , bacterial infection.■ Faculty of Pharmacy - Alexandria University (Egypt)
  102. 102. theEND Faculty of Pharmacy - Alexandria University (Egypt)

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