Lecture Notes: Constipation and Related Topics

Overview

• Focus on understanding risk factors and management for constipation.
• Interactive learning with drag-and-drop style questions.
• Importance of recognizing symptoms and risk factors for effective treatment.

Risk Factors for Constipation

• Diabetes: Poorly managed diabetes with high hemoglobin A1C can affect intestinal blood vessels, increasing constipation risk.
• Stress: Changes in routine, such as exams or travel, can lead to constipation.
• Medications:
  • Anti-diarrheal medications (e.g., diphenoxalate atropine) can slow bowel movements.
  • Opioids (e.g., hydrocodone) increase constipation risk.
  • Diuretics (e.g., furosemide) can dry out the body, reducing bowel fluid.
• Thyroid Disorders: Hypothyroidism increases constipation risk, while hyperthyroidism does not.

Understanding Constipation

• Defined as infrequent or difficult-to-pass stools, or the sensation of incomplete bowel evacuation.
• Can occur with:
  • Lack of stools or hard stools.
  • Abdominal pain, bloating, gas, and rectal pressure.

Causes of Constipation

• Insufficient fiber or fluids.
• Sedentary lifestyle.
• Certain medications.
• Pregnancy.

Assessment and Diagnosis

• Evaluate stool and bowel habits, diet, and symptoms like pain and bloating.
• Use Bristol Stool Scale for stool classification.
• Constipation can indicate more serious issues like colorectal cancer; consider occult stool testing and blood work.

Complications of Constipation

• Hemorrhoids: Swollen/Inflamed blood vessels caused by straining and prolonged toilet sitting.
• Vagal Stimulation: Can lead to passing out due to cardiovascular response to straining.
• Impaction and Diverticulitis: Risk of bowel obstruction and infected intestinal pouches.

Management of Hemorrhoids

• Stool softeners, pain relief, and sitz baths for comfort.
• Increase fluids, fiber, and movement.
• Severe cases may require hemorrhoidectomy.

Constipation Medications

• Types and Considerations:
  • Bulk-forming Laxatives: Fiber-based, like psyllium, with low dependency risk.
  • Emollients: Stool softeners, like docusate, affecting vitamin K absorption.
  • Saline/Osmotic Laxatives: Increase intestinal fluid; careful with magnesium in renal patients.
  • Stimulant Laxatives: Increase peristalsis but can cause dependency.
  • Enemas: Rapid relief but risk of dependency and electrolyte imbalance.

Lifestyle Modifications

• Increase fluid intake (2 liters/day), fiber (20-30 grams/day), and exercise (3x/week).
• Avoid delaying bowel movements and create a regular routine.

Dietary Considerations

• High Fiber Foods: Fruits, vegetables, whole grains.
• Low Fiber Foods: White rice, white bread.
• Encourage high fiber and discourage low fiber to manage constipation effectively.

Final Thoughts

• Creating a plan with indicated and contraindicated foods and treatments helps manage GI disorders.
• Awareness of colorectal cancer risk and importance of lifestyle changes in management.