Exclusion Criteria for Constipation Self-Care
● Age < 2 years old
● Dark, tarry or bloody stool
● Daily laxative use
● Fever/Nausea/vomiting
● Anorexia
|
● Chronic medical condition that precludes self-care laxative treatment
● Severe abdominal distention, cramping, or pain
● Severe or unexplained flatulence
● Severe change in stool character
● Unexplained bowel habit changes, especially with weight loss
● Bowel symptoms that continue for >2 weeks OR recur over 3 months or longer
● Bowel symptoms that persist after dietary or lifestyle changes or laxative use
|
Non-Pharmacological Treatment (FIRST-LINE)
Lifestyle changes |
‣ Balanced Diet
‣ Fiber: 14g per 1,000kcal -OR-
Women: 25 g/day
Men: 38 g/day
|
| |
Fluid Intake |
‣ 2 L water/day
‣ Pregnancy: extra 300 mL/day
‣ Lactating: extra 750 - 1,000 mL/day
|
| |
Exercise |
‣ 150 minutes/week |
| |
Bowel Training |
‣ Regularly-scheduled attempts (Usually first thing in the morning) |
SHELBS for Constipation
Saline |
Liquid and solid (PO), Liquid (rectal)
‣ Mag Citrate/Hydroxide/Sulfate
‣ Dibasic/Monobasic Sodium phosphate
|
Draw water into the intestine/colon (PO) via Osmosis
→ increase intraluminal pressure
→ promote GI motility
|
| |
Hyperosmotic |
‣ Glycerin (Rectal Suppository/Enema)
‣ PEG 3350 (PO powder) |
Large, poorly-absorbed ions/molecules draw water into the colon and rectum via osmosis |
| |
Emollients
(aka Stool Softeners) |
‣ Docusate Sodium/Calcium (PO Capsule and Syrup) |
Anionic Surfactants |
| |
Lubricants |
‣ Mineral oil (PO/PR Liquid) |
Coats stool and prevent colonic absorption of fecal water
→ softens fecal contents |
| |
Bulk-Forming (DOC) |
‣ Methylcellulose, polycarbophil, psyllium-containing products (PO) |
(Mimic what the body does naturally) Absorb water in intestine
→ provides bulk
→ promotes peristalsis |
| |
Stimulants |
‣ Senna, Bisacodyl (PO Caps/Tabs; PR Supp.) |
(Increase gastric motility in colon)
Local irritation of mucosa or more selective action on intramural nerve plexus of intestinal smooth muscle + increased water and electrolyte secretion by the intestine |
Fast vs. Slow Relief OTC
Faster Relief
(within 15 min - 6 hours) |
Lubricants
‣ Mineral oil (PR): 5-15 minutes |
| |
Saline Laxatives
‣ Magnesium citrate (PR): 2-15 min
‣ Magnesium citrate (PO): 30 min - 3 hours
‣ Magnesium hydroxide: 30 min-6 hours |
| |
Hyperosmotic
‣ Glycerin (PR): 15-30 minutes |
| |
Stimulants
‣ Bisacodyl (PR): 15-60 minutes
‣ Senna (PO): 6-10 hours
‣ Bisacodyl (PO): 6-10 hours |
| |
Slower Relief
(6+ hours, up to 72 hours) |
Bulk-Forming Agents
‣ Methylcellulose, Polycarbophil, Psyllium-containing products (PO): 12-24 hours, up to 72 hours |
| |
Emollients (Stool Softeners)
‣ Docusate Na/Ca: 12-72 hours, up to 3-5 days |
| |
Lubricants
‣ Mineral oil (PO): 6-8 hours |
| |
Hyperosmotic
‣ PEG 3350 (PO): 12-72 hours (up to 96 hours) |
Contraindication, Caution, and DDI with OTC
Saline |
AVOID IN:
‣ Intolerant of fluid loss, Electrolyte imbalances, Renal impairment, Newborns, Older adults, or CHF (sodium phosphate)
‣ PR Sodium phosphate: megacolon, GI obstruction, anus perforation, colostomy
|
| |
Hyperosmotic |
PEG 3350: Caution in renal disease, IBS |
| |
Glycerin: Pre-existing rectal irritation |
| |
Emollients
(aka Stool Softeners) |
Caution: Electrolyte imbalances |
| |
Lubricants |
Avoid in: < 6 years, Pregnancy, Bedridden, Older adults, Difficulty swallowing, Risk for aspiration because Risk of Lipid Pneumonia when taken PO |
| |
DDIs: Fat-soluble vitamins (ADEK) and Docusate (emollient) |
| |
Bulk-Forming (DOC) |
Avoid in: Difficulty swallowing, esophageal strictures, intestinal ulcerations/stenosis/disabling adhesions, and psyllium allergy |
| |
Caution: Renal disease (calcium content), diabetes, restricted caloric intake, fluid intake |
| |
DDIs: Digoxin, Anti-coagulants, Salicylates (separate by 2 hours) |
| |
Stimulants |
Senna: Melanotic pigmentation of colonic mucosa, may discolor urine (pink/red/violet/brown) |
Special Populations
Children |
Mild constipation
‣ Dietary Modifications: > 2 yo extra fiber intake = (age + 5 g/day)
‣ Behavioral Modifications: establish regular stooling time (if toilet trained) |
| |
IF Modifications insufficient in 2 – 6 years old
‣ PO: Senna, Docusate sodium, Magnesium hydroxide
‣ Rectal: Glycerin, mineral oil, sodium phosphate |
| |
IF Modifications insufficient in 6 – 12 years old
‣ PO: Senna, Docusate sodium, Magnesium hydroxide, bulk-forming, mineral oil, Magnesium (any formulation), Bisacodyl
‣ Rectal: Glycerin, mineral oil, sodium phosphate, Bisacodyl |
| |
Pregnancy/Lactation |
Goal: Achieve soft stools WITHOUT laxative use
‣ First-line: Dietary (increase fibers)
‣ Second-line: Bulk-forming with plenty of fluid, Docusate, PEG 3350, (maybe short-term) Senna/Bisacodyl
‣ Breastfeeding: Senna, Bisacodyl, PEG 3350, Docusate |
| |
Older Adults |
ALWAYS FLUID and FIBER |
| |
Bulk-forming Laxative (Avoid in dehydration, frailty, bedridden, unable to maintain hydration)
‣ If bulk-forming is contraindicated: PEG 3350 or Docusate
‣ AVOID: Mineral oil and Saline because of fluid and electrolyte imbalance |
|
Created By
Metadata
Comments
No comments yet. Add yours below!
Add a Comment
Related Cheat Sheets
More Cheat Sheets by chautommy93