Lecture 7+8 - Constipation.pptx - NON-PRESCRIPTION DRUGS Constipation Dr Mohammad Majed Al Ahmad PhD BCPS MSc DIP BSc Asst Professor College of Pharmacy

Lecture 7+8 - Constipation.pptx - NON-PRESCRIPTION DRUGS...

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NON-PRESCRIPTION DRUGS Constipation Dr. Mohammad Majed Al Ahmad, PhD, BCPS, MSc, DIP, BSc Asst. Professor College of Pharmacy Al Ain University of Science and Technology
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Introduct ion Constipation that is not secondary to underlying disease or caused by factors such as side-effects of drugs or laxative abuse is known as simple or functional constipation and may be self-treated on the basis of advice from a pharmacist.
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Defniti on 1. Bowel symptoms (difficult or infrequent passage of stool, hardness of stool, or a feeling of incomplete evacuation) that may occur in isolation or secondary to another underlying disorder. 2. The 2013 ACG (American college of gastroenterology) guidelines distinguish between normal-transit constipation and slow-transit constipation. Another definition is “a symptom based disorder defined as unsatisfactory defecation and is characterized by infrequent stools, difficult stool passage, or both”.
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Abdominal pain and distension may occur, as well as low back pain and anorexia. Frequency of bowel movement is variable and ranges from 3 times a day to three times a week. Regularity is what is "regular" or typical for the individual who experiences none of the classic symptoms of constipation. Therefore, constipation cannot be defined solely in terms of the number of bowel movements in any given period. Physiolo gy
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Pathophysiol ogy Common causes include: a. Altered motility (e.g., ileus) b. Neurogenic causes (autonomic neuropathies, Parkinson disease ) c.Endocrine or metabolic disorders (e.g., hypothyroidism, diabetes, hypokalemia, hypercalcemia, uremia) d. Pregnancy e. Psychogenic causes f. Structural abnormalities or obstruction g. Nutritional (e.g., reduced fiber-rich food and water intake) h. Medications Constipation that is not caused by an underlying organic cause is called chronic idiopathic constipation (CIC) or functional constipation.
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Caus es Avoiding the urge to empty the bowel can eventually lead to constipation. When this stimulus is ignored or suppressed, rectal muscles can lose tonicity and become less effective in eliminating stool Bowel evacuation is inhibited because of the consequent lack of stimulus of peristalsis in the colon.
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Common Causes of Drug-Induced Constipation
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Caus es
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Diagnosis 1. Need to evaluate patient history thoroughly a. Need to establish patient baseline and evaluate for disease- and drug- induced causes b. Assessment of fluid and electrolyte status, thyroid function c.Imaging (abdominal CT scan or radiograph) may be necessary to assess for ileus, obstruction, or dilatation.
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Diagno sis Referral for further evaluation may be necessary for some patient populations a. Symptoms for more than 1-2 weeks despite treatment b. Considerable pain or cramping c. Pregnancy d. Presence of fever e. Blood in the stool f. Reduction in stool caliber (change in stool characteristics that allow it to be narrower) g. Weight loss h. Paraplegia, quadriplegia i. Nausea and/or vomiting j. Daily laxative use k. History of IBS l. Anorexia
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Diagno sis Diagnosis of
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