first presentation

1. 2 CONSTIPATION AND
BOWEL CLEANSING

2. 2.1 BOWEL CLEANSING

3. 2.2 CONSTIPATION

4. Constipation TREATMENT
S
S
O
B
LIFESTYLE ADVICE is first-line.
5 portions of FRUIT AND VEG
18-30g of FIBRE a day
FLUID INTAKE of 2.5 litres
EXERCISE 30 mins/ 5 days a week
ALCOHOL 2-3 units a day + few alcohol-free days.
MAX. 14 UNITS - men and women *new guidelines*
TOILETING HABITS
Squatting, don’t hurry, attempt to go first thing in morning
or 30 minutes after a meal and respond to urge to defecate.

5. Bulk-forming laxatives
S
S
O
B
FIRST-LINE after lifestyle advice.
Ideal for
SMALL, hard stools.
Diets deficient in FIBRE.
Swells in gut to INCREASE FEACAL MASS
and stimulates peristalsis.
Works within 24 hours
but takes 2-3 DAYS FOR FULL EFFECT.

6. Bulk-forming laxatives
S
S
O
B
SIDE EFFECTS
Abdominal distension, flatulence and
esophageal or intestinal obstruction.
Caution in reduced mobility, intestinal narrowing
and the elderly– higher risk of obstruction.

7. Bulk-forming laxatives
S
S
O
B
COUNSELLING POINTS
Maintain adequate fluid intake
to avoid gut obstruction -may be difficult in the
elderly or frail.
Swallow with water and
not immediately before bed.

8. Bulk-forming laxatives
S
S
O
B
TREATMENT
6+ ISPHAGULA HUSK Fybogel
6+ STERCULIA Normacol
METHYLCELLULOSE Celevac

9. Osmotic laxatives
S
S
B
O
SECOND-LINE switch to or add osmotic
if
Stools are STILL HARD.
INCREASES WATER IN COLON By drawing
fluid from body or retains fluid administered with.
Works in 2-3 days but
48 hours for lactulose.

10. Osmotic laxatives
S
S
B
O
SIDE EFFECTS
Discomfort, flatulence and cramps
- at the start of treatment.

11. Osmotic laxatives
S
S
B
O
TREATMENT
MACROGOL 3350 Movicol/Laxido
3 months+ LACTULOSE

12. Stimulant laxatives
S
O
B
S
THIRD-LINE
if
Stools are soft but
DIFFICULT TO PASS.
INCREASES INTESTINAL MOTILITY by
irritating gut lining.
Works in 6-12 hours
Works in 15-30 mins - Glycerin suppositories

13. Stimulant laxatives
S
O
B
S
SIDE EFFECTS
Abdominal cramps.
EXCESSIVE USE causes hypOKalaemia
and diarrhea, and may result in a lazy bowel
– makes constipation worse.
CONTRAINDICATED
Intestinal obstruction.
c

14. Stimulant laxatives
S
O
B
S TREATMENT
6+ SENNA Senokot
Short-term use - 1 week.
COUNSELLING: urine coloured yellow/brown
GLYCERIN SUPPOSITORIES
Local rectal stimulant and lubricant.

15. Stimulant laxatives
S
O
B
S
TREATMENT
10+ BISACODYL Dulcolax
4+ SODIUM PICOSULFATE Dulco-lax
12+ DOCUSATE SODIUM Dioctyl
-also has stool softening properties

16. Stimulant laxatives
S
O
B
S
TREATMENT
DANTRON(co-danthramer/co-danthrusate)
is CARCINOGENIC - use in terminally
ill only.
SIDE EFFECTS
Colours urine red.
Local irritation/ excoriation. Avoid prolonged
contact with skin in incontinent patients.

17. Stool softener laxatives
S
O
B
S
NOT RECOMMENDED.
LIQUID PARAFFIN- is a traditional
lubricant.
HARSH SIDE EFFECTS
Anal seepage, lipoid pneumonia and
malabsorption of fat-soluble vitamins ADEK.