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Large numbers of adults attend GP practices seeking advice on constipation, and GPs in England spend around £92 million a year on laxative prescriptions.1, 2 In an average month, 500 000 litres of lactulose are prescribed by GPs in England.3 Constipation is defined as: ‘Defecation that is unsatisfactory, because of infrequent stools, difficult stool passage or seemingly incomplete defecation.’ 4 Constipation is a subjective symptom based on a person’s expectations of bowel frequency, stool volume, consistency and ease in passing stool. The Rome diagnostic criteria (Table 1) can help diagnose constipation.5 Constipation can be acute or chronic. Chronic constipation affects 14% of adults worldwide. Women are twice as likely to seek treatment for it as men, and women of childbearing age are more likely than older women to seek treatment. It is thought that oestrogen and progesterone the female sex hormones make the colon more sluggish.6 There is a higher prevalence in people of lower socioeconomic status.7 Bowel function
Note: This guideline is currently under review. Aim Definition of Terms Assessment Management Special Considerations Education Companion Documents Evidence Table IntroductionConstipation is one of the most frequent, adverse reactions that can occur post-operatively secondary to a reduction in fluid intake, immobility and medications such as opioids. Faecal impaction may occur causing pain and discomfort for patients as well as increasing the length of hospital stay. AimThe aim of this guideline is to assist nurses' who work within the paediatric field around the prevention and management of constipation in the post-operative patient. Definition of terms
AssessmentAll post-operative patients are at risk of developing constipation as a result of a variety of factors. Constipation can be an adverse drug effect from opioid use due to the action upon opioid receptors in the gastrointestinal tract. This leads to a reduction in gastrointestinal propulsion and an increase in fluid absorption. If the patient reports difficulty in passing stools, have not had their bowels opened post op or are currently on opioids the following must be considered:
Physical Assessment
Management
Special considerations
Education
Companion documentsKids Health Info – Constipation Table 1
Note: please refer to RCH policies and procedures for medications that can be nurse initiated https://www.rch.org.au/policy/policies/Medication_Management/ Evidence tableClick here to view the evidence table. Please remember to read the disclaimer. Which drug used to treat constipation acts by stimulation of nerves?Glycerin and bisacodyl are available without prescription as suppositories for use in constipation. Glycerin appears to work by stimulating an osmotic effect in the rectum. Bisacodyl exerts its action on neurons in the rectum, prompting defecation.
Which drug categories are known to exacerbate constipation?8 medications that cause constipation. Opioid pain relievers.. Nonsteroidal anti-inflammatory drugs (NSAIDs). Antihistamines.. Tricyclic antidepressants.. Urinary incontinence medications.. Iron supplements.. Blood pressure medications.. Anti-nausea medications.. Which agent is osmotic and used to treat constipation?Basically, osmotic agents, such as polyethylene glycol found in MiraLAX®, work naturally with the water in the colon to unblock a person's system. Soluble, non-absorbable PEG 3350 hydrates, softens and eases stools by gently attracting water in the colon through a process known as osmosis.
What recommendations should be included in client teaching as a means of avoiding constipation?Getting more exercise: Regular exercise can help keep stool moving through the colon. Drinking more water: Aim for eight glasses daily, and avoid caffeine, as it can be dehydrating. Go when you feel like it: When you feel the urge to go, don't wait.
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