Transcript Constipation

Constipation
Dianne Naylor
Physiotherapist
BTHFT May 2012
Definition
• Rome Criteria
( At least 2 of the symptoms below in any 12 week
period during the last 12 months )
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Fewer than 3 BMs per week
Hard stools >25% BMs
A sense of incomplete evacuation > 25% BMs
Excessive straining > 25% BMs
A need for digitation to facilitate evacuation
Motility disorders
• Insufficient fibre and/or fluids
• Impaired motility
• Psychiatric factors
Pelvic floor disorders
• Anismus
• prolapse
The elderly
• Colorectal function is not significantly effected
by the ageing process. Yet, older people are 5x
more likely to develop constipation. It is due
to an increase in constipating factors such as:
• Chronic illness
• Immobility
• Polypharmacy
• Neurological and psychiatric conditions
Causes
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Inadequate dietary fibre and fluids
Ignoring the urge to defaecate
Structural (colorectal blockages, prolapse)
Systemic (Hypothyroidism, Diabetes mellitus)
Neurological (Parkinsons, MS, CVA)
Drugs ( next slide)
Drugs that can cause constipation
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Opiates
Anticholinergics
Antidepressants
Antipsychotics
Anticonvulsants
Antacids
Antihypertensives
Calcium channel blockers
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Diuretics
Ganglionic blockers
Iron supplements
NSAIDs
Cholestyramine
Treatment
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Change lifestyle and diet
Stop medications which cause constipation
Toileting regimes
Bulk forming agents
Osmotic laxatives
Pelvic floor physiotherapy
Lifestyle and diet
• Firstly increase fluids and dietary fibre
• Increase exercise
• Toileting regime
Bulk forming agents
• Fibre and bulk forming agents decrease
abdominal pain and improve stool consistency
• Examples: Ispaghula husk and Psyllium husk
Osmotic laxatives
• Retain water in the bowel by osmosis. Good
fluid input is important
• Examples: Lactulose, Polyethylene glycol
Stimulant laxatives
• Act by directly stimulating the colonic nerves.
The effect is usually within 8-12 hours
• Examples: Senna, Docusate, Bisacodyl
• Contrary to commonly held opinion, long term
laxative use does not pose any risks and does
not lead to a “lazier bowel”
• For slow transit it is better to use stimulant
laxatives instead of bulking agents
• Senna/fibre combinations are more effective
than lactulose in the elderly
Physiotherapy
• Pelvic floor exercises (Lift analogy) (10/10/10)
• Defaecatory techniques