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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 ) Fewer than 3 BMs per week Hard stools >25% BMs A sense of incomplete evacuation > 25% BMs

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Constipation

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  1. Constipation Dianne Naylor Physiotherapist BTHFT May 2012

  2. Definition • Rome Criteria ( At least 2 of the symptoms below in any 12 week period during the last 12 months ) • 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

  3. Motility disorders • Insufficient fibre and/or fluids • Impaired motility • Psychiatric factors

  4. Pelvic floor disorders • Anismus • prolapse

  5. 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

  6. Causes • 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)

  7. Drugs that can cause constipation Diuretics Ganglionic blockers Iron supplements NSAIDs Cholestyramine • Opiates • Anticholinergics • Antidepressants • Antipsychotics • Anticonvulsants • Antacids • Antihypertensives • Calcium channel blockers

  8. Treatment • Change lifestyle and diet • Stop medications which cause constipation • Toileting regimes • Bulk forming agents • Osmotic laxatives • Pelvic floor physiotherapy

  9. Lifestyle and diet • Firstly increase fluids and dietary fibre • Increase exercise • Toileting regime

  10. Bulk forming agents • Fibre and bulk forming agents decrease abdominal pain and improve stool consistency • Examples: Ispaghula husk and Psyllium husk

  11. Osmotic laxatives • Retain water in the bowel by osmosis. Good fluid input is important • Examples: Lactulose, Polyethylene glycol

  12. 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

  13. Physiotherapy • Pelvic floor exercises (Lift analogy) (10/10/10) • Defaecatory techniques

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