Guidelines & References
Handbook p200 |
List of laxatives handbook p205 |
What is it?
Constipation is when it becomes hard to pass bowel motions, or you’re going less often than usual (e.g., fewer than 3 times per week) |
Bristol - Type 1-2 |
Types
Primary |
Secondary |
Normal Transit constipation (NTC) (most common): overlaps with IBS |
Cognitive impairement |
Slow transit constipation (ST-C): increased transit time, reduced colonic notility |
Depression, anxiety, EDs |
Dyssynergia defecation: poor coordination of pelvic floor and anal spinchter |
Immobility |
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Medications - uraemia, hypothyroidism, hypercalcemia, celiac disease |
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Surgical complications |
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Structural: tumours, stricture, surgical stenosis (a narrowing that restricts flow) |
Causes
Low fibre |
Inadequate fluid |
Lack of movement |
Stress |
Medication |
Objectives
↑ stool frequency and soften stool consistency |
Achieve fibre intake of ≥25–30g/day |
Achieve/maintain fluid intake at 1.5–2L/day |
Promote regular bowel habits and physical activity |
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Diagnosis
ROME IV Diagnosis Criteria |
1: Two or more of the following: straining during more than 20% of defaecations. Lumpy/hard stools (T1-2). Sensations of incomplete evacuation more than 25%. Sensation of blockage more than 25%. Fewer than 3 bowel movements/week. |
2: Loose stools are rarely present without the use of laxitives |
3: Insufficient criteria for IBS |
Assessment
Fibre intake |
Fluid intake |
Medications |
Laxatives/stool softeners |
Fam hx bowel cancer |
Daily stress/depression/anxiety |
PA |
Travel/changes in routine |
Ignoring the urge to go |
Bowel routine |
Appetite & general intake |
Overflow diarrhoea? |
N/V |
Strategies
Eat more fibre-rich foods: wholegrain breads/cereals, fruits with skin, legumes, vegetables |
Start your day with high-fibre breakfast cereals (e.g., bran, oats) |
Drink plenty of water – especially if increasing fibre |
Prunes, kiwi fruit, psyllium husk or flaxseed may help with regularity |
Establish a toilet routine, e.g., 15–30 minutes after breakfast |
Discuss appropriate use of fibre supplements or stool softeners |
Squatty Potty (better position) |
Before going to toilet - go for a short walk, cup of warm fluids (eg. tea/coffee) |
Colonoscopy for 40+ years |
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Physical Findings Dehydration
Findings |
Moderate |
Severe |
Behaviour |
Normal to listless (low energy, motivation, or enthusiasm |
Normal to comatose (coma/unconscious) |
BP |
Orthostatic (drop in BP due to this positional change) |
Decreased |
Core body temp |
rises 0.15 to 0.2 degrees for every 1% of BW lost due to sweating |
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Eyes |
Sunken |
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Mucous membranes |
Dry |
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Pulse |
Thready (weak, faint, rapid or barely perceptible) |
Faint, impalpable (cannot be felt) |
Resp Rate |
Increased |
Fast, hyperpnoea (increased depth of breathing) |
Urine output |
Oliguria (low, <500 mL/day in adults) |
〃, anuria (very little/no urine output, typically <100mL/day) |
Example PESS
Inadequate fluid intake |
insufficient access to fluid at work |
Inadequate fibre intake |
food and nutrition-related knowledge deficit |
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