170 likes | 508 Views
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
E N D
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 • 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 • 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 Diuretics Ganglionic blockers Iron supplements NSAIDs Cholestyramine • Opiates • Anticholinergics • Antidepressants • Antipsychotics • Anticonvulsants • Antacids • Antihypertensives • Calcium channel blockers
Treatment • 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