Constipation
● Hard, dry stools less frequently than the person’s normal bowel movements
● May be associated with symptoms of abdominal discomfort, bloating and nausea
● Patients may define constipation as passing hard stools or straining, incomplete or
painful defecation
● Symptoms - painful bowel movements, bloated, uncomfortable, sluggish
● Complication - faecal impaction, faecal and urinary incontinence, rectal bleeding
haemorrhoids and fissures
● Medications that can cause constipation: diuretics, antidepressants, iron supplements,
antacids containing aluminium, analgesia
Type 1 - 2 = Constipated
Type 3- 4 = Normal
Type 5 = lacking fibre
Type 6 - 7 = Inflammation
Specific questions to ask:
● Pain on passing stool?
● Is there any blood present?
● Any other symptoms?
● Any changes in diet?
, Type of laxative Example Information
Bulk-forming Ispaghula - Fybogel MOA: retains water in the gut; increases
Sterculia faecal bulk; stimulates peristalsis
Methylcellulose Works within up to 72 hours
Dietary fibres Side effects: bloating, distension and
Bran flatulence
Adequate fluid intake must be maintained to
avoid intestinal obstruction
Not recommended for people taking
constipating drugs
Safe for long term use as it is not absorbed
from the intestines
Safe for elderly patients
For prevention, not immediate relief
Osmotic laxatives Lactulose MOA: increases amount of water in the large
SE: flatulence, bowel (water absorption), either by drawing
cramps and fluid from the body into the bowel or by
abdominal retaining the fluid they were administered
discomfort with
Prolonged use in Works within 4-48 hours
children - can Adequate water intake with lactulose
cause dental
caries; Sweet
taste can be
unpalatable
Macrogols - Movicol
Stimulant laxatives Bisacodyl MOA: increases intestinal motility and often
Senna - excreted via the causes abdominal cramp
kidney and may colour Works within 8-12 hours
the urine yellow-brown to Taken at night, provides overnight relief,
red colour defecate in the morning
!Risk of fluid and electrolyte imbalance if
used frequently + Dehydration!
If used for long term can lead to loss of
colon function and as a result constipation
becomes increasingly worse and
unresponsive to laxatives
Senna and breastfeeding - can enter breast
milk and cause colic and diarrhoea in infany
Stool softeners Docusate sodium - MOA: prevents hardening of the faeces by
Dulcoease adding moisture to the stool, becomes
● Hard, dry stools less frequently than the person’s normal bowel movements
● May be associated with symptoms of abdominal discomfort, bloating and nausea
● Patients may define constipation as passing hard stools or straining, incomplete or
painful defecation
● Symptoms - painful bowel movements, bloated, uncomfortable, sluggish
● Complication - faecal impaction, faecal and urinary incontinence, rectal bleeding
haemorrhoids and fissures
● Medications that can cause constipation: diuretics, antidepressants, iron supplements,
antacids containing aluminium, analgesia
Type 1 - 2 = Constipated
Type 3- 4 = Normal
Type 5 = lacking fibre
Type 6 - 7 = Inflammation
Specific questions to ask:
● Pain on passing stool?
● Is there any blood present?
● Any other symptoms?
● Any changes in diet?
, Type of laxative Example Information
Bulk-forming Ispaghula - Fybogel MOA: retains water in the gut; increases
Sterculia faecal bulk; stimulates peristalsis
Methylcellulose Works within up to 72 hours
Dietary fibres Side effects: bloating, distension and
Bran flatulence
Adequate fluid intake must be maintained to
avoid intestinal obstruction
Not recommended for people taking
constipating drugs
Safe for long term use as it is not absorbed
from the intestines
Safe for elderly patients
For prevention, not immediate relief
Osmotic laxatives Lactulose MOA: increases amount of water in the large
SE: flatulence, bowel (water absorption), either by drawing
cramps and fluid from the body into the bowel or by
abdominal retaining the fluid they were administered
discomfort with
Prolonged use in Works within 4-48 hours
children - can Adequate water intake with lactulose
cause dental
caries; Sweet
taste can be
unpalatable
Macrogols - Movicol
Stimulant laxatives Bisacodyl MOA: increases intestinal motility and often
Senna - excreted via the causes abdominal cramp
kidney and may colour Works within 8-12 hours
the urine yellow-brown to Taken at night, provides overnight relief,
red colour defecate in the morning
!Risk of fluid and electrolyte imbalance if
used frequently + Dehydration!
If used for long term can lead to loss of
colon function and as a result constipation
becomes increasingly worse and
unresponsive to laxatives
Senna and breastfeeding - can enter breast
milk and cause colic and diarrhoea in infany
Stool softeners Docusate sodium - MOA: prevents hardening of the faeces by
Dulcoease adding moisture to the stool, becomes
