constipation

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Faculty of Pharmacy - Alexandria University (Egypt)

Question . 1I am 30 years old and my stool Frequency decreased from three times per day to once every two days:

Am I constipated?What are the major symptoms of constipation?Faculty of Pharmacy - Alexandria University (Egypt)

What is Constipation?Decrease in the frequency in of fecal elimination.Passage of hard, dry, sometimes painful stool.

From 3 times daily to 3 times per week.

Normal Range* So the patient is not constipatedFaculty of Pharmacy - Alexandria University (Egypt)

Patient CounselingLife Style causes of constipation:

Diet:Inadequate fluid intakeShould drink at least 8 glasses of non-caffeinated fluids daily.

EtiologyFaculty of Pharmacy - Alexandria University (Egypt)

Patient CounselingInadequate dietary fibersDiets include a good quantity of fibers are less likely to suffer from constipation.Fiber retains water, softening stool & ease evacuation.Foods low in fiber high fat food.Foods rich in fiber fruits, veg. and whole grain.Normal daily fiber intake 10 25 g.

EtiologyFaculty of Pharmacy - Alexandria University (Egypt)Patient Counseling

Inadequate exercisesWalking help prevent constipation by promoting bowel motility.

Loss of defecatory reflexIf you ignore the urge to have a bowel movement. The urge can gradually go away.The longer can you delay it, the drier and harder stool will become.

Etiology



Question . 2My grandmother usually feels discomfort from chronic constipation:

What are reasons for this problem?What are your advice?Faculty of Pharmacy - Alexandria University (Egypt)

Epidemiology Constipation is common in elderly people ( > 65 y.) Laxative abuse gut motility Medication use Poor nutrition Females are three times more likely to suffer from constipation than males


Your adviceLaxative abuse:Lead to cathartic colon (loss of tone of intestinal muscles) cause poor bowel function.

Increase intake fluids & fibers. Increase exercise ( bowel tone).


Question . 3My wife is pregnant she is worried about constipation, I would like to know:

What is the factors that predispose pregnant to constipation?Faculty of Pharmacy - Alexandria University (Egypt)Factors which constipate pregnant


Question . 4Is there a relationship between anal disorders as abscesses and constipation?Faculty of Pharmacy - Alexandria University (Egypt)AbscessIt is a collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue.Usually caused by bacteria or parasites infection.Faculty of Pharmacy - Alexandria University (Egypt)Perianal abscessesFound in patients with inflammatory bowel disease (Crohn's disease) or diabetes.

Relationship FoundFaculty of Pharmacy - Alexandria University (Egypt)

Question . 5I heard that there is a medical condition called Colonic inertia:

What is it?How diet can affect colonic motility?Faculty of Pharmacy - Alexandria University (Egypt)Colonic InertiaProlonged colon transit time The average time of passage through the GIT is 4 days.Faculty of Pharmacy - Alexandria University (Egypt)

Diet & Colonic motilityMotility may be stimulated by boosting carbohydrates intake while limiting protein.

Faculty of Pharmacy - Alexandria University (Egypt)Question . 6Is it true that some health problems may lead to constipation?

Explain your answer.

Faculty of Pharmacy - Alexandria University (Egypt)PainDuring defecation avoidance constipation.

CausesPassage of hard stool.Anal fissures and abscess.Hemorrhoids.

Faculty of Pharmacy - Alexandria University (Egypt)Health problems may lead to constipationCarcinomaIrritable bowel syndrome (IBS) common cause in younger peopleDiabetes 60% of diabetics patientRenal failure due to electrolyte & fluid disturbanceFaculty of Pharmacy - Alexandria University (Egypt)Parkinsonism up normal gut motility & rigid musclesColonic inertiaPregnancyHealth problems may lead to constipationFaculty of Pharmacy - Alexandria University (Egypt)

Question . 7I am taking Hma-Caps for anemia:

Is that related to constipation I am suffering these days?

What are the others drugs that can cause constipation?Faculty of Pharmacy - Alexandria University (Egypt)

Iron vs. ConstipationIron slow down the digestive system & slowing of normal bowel movement.This may be because iron is a metal in its basic form. Metals carry a charge that can affecting muscles and nerves in the bowelFaculty of Pharmacy - Alexandria University (Egypt)Drugs cause constipationNarcotic analgesicsDiureticsAnticonvulsantsSympathomimetics or anticholinergicAntihistaminicAntacids (containing Ca2+,Al3+)Faculty of Pharmacy - Alexandria University (Egypt)Question . 8My brother suffers from chronic constipation. He starts taking Purgaton tablets on regular basis. First the condition improved but now the case is worse.

What do you think?


Purgaton tabletContain senna glycosides (anthraquinone)

With extended use cause lazy bowel syndrome (atonic colon)Bowel unable to move without chemical stimulation.Faculty of Pharmacy - Alexandria University (Egypt) My mother suffers from abdominal discomfort as a result of constipation but she refuses taking laxatives. Could you tell me the appropriate life style modifications for her to follow ? Question . 9

Faculty of Pharmacy - Alexandria University (Egypt)Life style modificationsincreased intake of water, and fiber (either dietary or as supplements).

The routine use of laxatives is discouraged, as having bowel movements may come to be dependent upon their use. Faculty of Pharmacy - Alexandria University (Egypt)Life style modificationsEnemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract.

Faculty of Pharmacy - Alexandria University (Egypt)Constipation may be a sign for many serious health problems . Is that true? Explain

Question . 10Faculty of Pharmacy - Alexandria University (Egypt)General precautions

Faculty of Pharmacy - Alexandria University (Egypt)Question . 11I have constipation and want to know the different classes of drugs that I can use for treatment?Faculty of Pharmacy - Alexandria University (Egypt)Types of laxativeBulk laxativeNatural or synthetic polysaccharide derivatives that absorb water to soften stool.Slow onset of action (12-24 hr).E.g. Psyllium & malt soup extract (natural) Methyl cellulose (Synthetic)Faculty of Pharmacy - Alexandria University (Egypt)Types of laxativeBulk laxativeShouldn't used with patient have an obstructing bowel legion.Used for protection from constipation.Used for pregnant.Faculty of Pharmacy - Alexandria University (Egypt)Types of laxativeStimulant laxativeWork on small and large intestine to simulate bowel motility.Onset of action 6-12 hr orallyShouldnt used more than 1 week.Should avoid in pregnancyFaculty of Pharmacy - Alexandria University (Egypt)Types of laxativeStimulant laxativeE.g.Senna glycoside (Anthraquinone)Castor oilStrong cathartic effectLead to dehydration


Types of laxativeBisacodylDiphenyl derivativeEnteric coated Avoided with H2 blockerFaculty of Pharmacy - Alexandria University (Egypt)Types of laxativeEmollient laxative

Stool softenersSlow onset 24 72 hr. Used for prevention than treatment.

Faculty of Pharmacy - Alexandria University (Egypt)Types of laxativeLubricant laxativesMineral oil (as liquid paraffin)Increase water retention in colonOnset 6 8 hr orally5 15 min rectallyCause anal seepage results in etchingDecrease absorption of fat-soluble vit.


Types of laxativeLubricant laxativesShould take on empty stomachShouldnt take at bed timeShouldnt given to children < 6 yearsFaculty of Pharmacy - Alexandria University (Egypt)Question . 12My wife is pregnant and she is complaining of constipation . If you don't mind recommend her the appropriate medication illustrating how it works. And how to use it properly ?Faculty of Pharmacy - Alexandria University (Egypt)Bulk forming laxativeNatural or synthetic polysaccharide derivative that absorb H2O to soften the stool and increase bulk.Onset of action of these agents is slow (12-24 hr and up to hr), which is why they are the best used to prevent constipation rather than to treat severe acute constipation.Faculty of Pharmacy - Alexandria University (Egypt)How to use?

Faculty of Pharmacy - Alexandria University (Egypt)Question . 13My grandmother is constipated but cannot swallow oral tablets. What other dosage form are available?

Faculty of Pharmacy - Alexandria University (Egypt)Dosage formSyrup as DuphalacSuppositories as Glycerin , Bisadyl Oral drops as Picolax Enema as Enemax


Faculty of Pharmacy - Alexandria University (Egypt)Question . 14 My grandfather is taking many medication for his CHF and rheumatic pain but the condition is not improving also can he takes Regumucil sachets and Epsom salt for constipation?

Faculty of Pharmacy - Alexandria University (Egypt)AnswerDose spacing is essential with digitalis for (CHF) and salicylates as the laxative may reduce the effectiveness of the medication.Faculty of Pharmacy - Alexandria University (Egypt)Question . 15 My baby is usually straining during defecation. What is the best OTC medication for his condition?Faculty of Pharmacy - Alexandria University (Egypt)AnswerThe first question to ask: Is my child really constipated if he is constipated so glycerin pediatric suppositories is considered.Faculty of Pharmacy - Alexandria University (Egypt)Question . 16 My friend suggest me enemas as rapid treatment for constipation, what do they contain? and what they advantage?

Faculty of Pharmacy - Alexandria University (Egypt)EnemasDi-Na Phosphate and Mono-Na Ph.They are highly hygroscopic and water soluble.

Faculty of Pharmacy - Alexandria University (Egypt)AdvantagesRapid & effortless evacuation of the bowel Used in cases of: Cardiac patientsGlaucomaOphthalmic surgeryPost operative


My grandfather suffer from hepatic encephalopathy, is there is any laxative that can help in his condition ?

What are the precaution concerning its use? (Counseling and interactions)

Question . 17Faculty of Pharmacy - Alexandria University (Egypt)A) Is there is any laxative that can help in his condition? Lactulose

Duphalak syrup. Lactulose syrup.

Faculty of Pharmacy - Alexandria University (Egypt)B) What are the precautions concerning its use? (Counseling and interactions)1-It may take from (1-3)days to act so useful in treatment of chronic constipation in adults

2-It shouldnt be taken concomitantly with locally acting aminoglycoside antibiotics.

3-It should be taken with fruit juice, water or milk to increase its palatability.Faculty of Pharmacy - Alexandria University (Egypt)My brother abuse taking Mucinum cascara tablets for constipation, what is your advice?A: Mucinum cascara tablets shouldnt be used for more than 1 week.

B: Chronic use of this stimulant laxative leads to cathartic colon resulting in a poorly functioning colon .

Question . 18Faculty of Pharmacy - Alexandria University (Egypt)C: It may show the symptoms of ulcerative colitis. Also, it may discolor the urine with pink to red or brown to black.


Question . 19Abilaxine tab are effective in reliving constipation . Comment on their administration immediately after meals or with Epicogel suspension.

Faculty of Pharmacy - Alexandria University (Egypt)BisacodylAbilaxine is containing Bisacodyl formed as an enteric coated tablet .All biscodyl containing product shouldn't be taken within an hour of ingesting food or antacid (as epicogel) or milk.Should be avoided in patient tacking H2 blocker.

Faculty of Pharmacy - Alexandria University (Egypt)My sister is pregnant; can she take castor oil or Minalax tablets for constipation?What is docusate? Mention its medicinal syndromes.Can she take castor oil or Minalax tablets for constipation?No she cannot take castor oil because of its dangerQuestion . 20Faculty of Pharmacy - Alexandria University (Egypt)

What is the danger of Castor oil in this case?Premature labor due to premature uterine contractions.

Death due to amniotic air embolism.

Impaired health of the infant.Faculty of Pharmacy - Alexandria University (Egypt)But, she can take Minalax tablets because :-

1- It is emollient laxative (stool softener) which is safe.

2- It acts as surfactant by allowing absorption of water into the stool so; It makes the softened stool easier to pass.

Faculty of Pharmacy - Alexandria University (Egypt)B) What is docusate? It is emollient laxative (stool softener).

They act as surfactant by allowing absorption of water into the stool so; it makes the softened stool easier to pass).Faculty of Pharmacy - Alexandria University (Egypt)C) Mention its medicinal syndromes?For patients who must avoid straining to pass hard stools. as those recently have a myocardial infarction or rectal surgery.Safe for pregnant.

Faculty of Pharmacy - Alexandria University (Egypt)I prefer taking paraffin as laxative. What is your advice?

How about using it concomitantly with Minalax tablets in severe constipation?Question . 21Faculty of Pharmacy - Alexandria University (Egypt)A:- My advice:-

It should be taken on an empty stomach.(Because of its possible aspiration into the lungs, lipid pneumonitis may occur).

Patients shouldnt take it at bed time or recline after administration.Faculty of Pharmacy - Alexandria University (Egypt)B) How about using it concomitantly with Minalax tablets in severe constipation?Minalax may increase the systemic absorption of paraffin leading to hepatotoxicity.

Faculty of Pharmacy - Alexandria University (Egypt)I am suffering from chronic constipation and usually strain during defecation. Can this lead to hemorrhoids? And are there are any other causes?(Define hemorrhoids and mention its etiology and epidemiology).A) Can this lead to hemorrhoids?- Yes, hemorrhoids will occur.

Question . 22Faculty of Pharmacy - Alexandria University (Egypt)B) Define hemorrhoidsHemorrhoids refers to a condition in which the veins around the anus or lower rectum are swollen, inflamed and abnormally large.

Simply, hemorrhoids represent downward displacement of anal cushions that contain arteriovenous anastomoses.


B. Etiology1- Hereditary.

2-Acquired factors:

Straining during defecation push the hemorrhoid veins downward with increased venous pressure, they dilate and become engorged.

Faculty of Pharmacy - Alexandria University (Egypt)Over time the fibers that anchor the hemorrhoidal veins to their underlying muscular coats stretch which result in prolapsed.

Occupations that require heavy lifting can transform asymptomatic hemorrhoids into a problem.

Faculty of Pharmacy - Alexandria University (Egypt)C) Epidemiology The risk of developing hemorrhoids increases with advanced age and pregnancy.


Faculty of Pharmacy - Alexandria University (Egypt)Hemorrhoid (piles) Is a condition in which the veins around the anus or lower rectum are swollen and inflamed Risk of developing hemorrhoid increase with advanced age and pregnancy. It may internal or external or mixed.

I am feeling discomfort in the anal area, a friend suggested I am suffering from Hemorrhoids; I want to know if my symptoms can be caused by any other condition and what are the other symptoms of hemorrhoids?Question . 23Faculty of Pharmacy - Alexandria University (Egypt)Other conditionsA similar knife-like pain can be caused by herpes simplex virus.aching discomfort made worse by defecation could be due to piles.A throbbing pain, worsening over a few days, and bad enough to disturb your sleep.Faculty of Pharmacy - Alexandria University (Egypt)Other conditionsAn occasional, severe, cramp-like pain deep in the anal canal.A continuous aching pain in the anus needs to be sorted out by your doctor..Faculty of Pharmacy - Alexandria University (Egypt)Symptoms of HemorrhoidBleeding during bowel movements, itching, and rectal pain are the most common hemorrhoid symptoms.

Internal hemorrhoidsRectal bleeding, Itching , skin irritation and pain.

External hemorrhoidsRectal pain occurs mainly.Blood may pool under the skin, forming a hard, painful lump.This is called a thrombosed, or clotted.Faculty of Pharmacy - Alexandria University (Egypt)I know that hemorrhoids can be classified into different types. Please tell me these types and how each type is treated?Question . 24Faculty of Pharmacy - Alexandria University (Egypt)External Hemorrhoidsoccurs outside of the anal canal. very painful Its very common for these type of hemorrhoids to bleed.Blood can often be found on the stool or toilet paper.Faculty of Pharmacy - Alexandria University (Egypt)Internal HemorrhoidsOccur inside the anal canal.Internal hemorrhoids dont usually cause as much pain as external. Internal hemorrhoids come about when there is too much pressure on the veins inside the anal canal.

Faculty of Pharmacy - Alexandria University (Egypt)Other classificationFirst degree :painless bleeding is presentSecond degree : descend with defecation but returns spontaneously with relaxation.Third degree : requires manual replacement into rectum after prolapse. pain ,bleeding are presentFourth degree : can't be manipulated manually . thrombosis often occurFaculty of Pharmacy - Alexandria University (Egypt)TreatmentFor external hemorrhoids which are still not bleeding and have not yet thrombosed, this could be treated with a hemorrhoid cream, ointment, warm baths, witch hazel.

Mild internal hemorrhoids could also be cured with suppositories of hemorrhoid cream, witch hazel, and possibly by using a supplement.

Faculty of Pharmacy - Alexandria University (Egypt)Treatmentwhen your hemorrhoids have thrombosed, prolapsed more intensive treatment may be recommended. Some of the options include hemorrhoid surgery, and laser coagulation. Higher degree of internal hemorrhoids:Hemorrhoid banding is a procedure in which the physician puts a tight band around the hemorrhoid to control bleedingFaculty of Pharmacy - Alexandria University (Egypt)TreatmentInfrared photocoagulation: infrared light is focused at the base of hemorrhoids Sclerotherapy: injection of aseclerosing agent into the hemorrhoidsCryotherapy: freezing the hemorrhoids

Faculty of Pharmacy - Alexandria University (Egypt)My brother suffer hemorrhoid he relies on self treatment, but could you tell me when should he consult doctor?

IF these products don't improve symptoms within seven days , if severe bleeding ,pain happen, if patient below 12 years old. So you should consult your doctors to seek the medical attention immediatelyQuestion . 25Faculty of Pharmacy - Alexandria University (Egypt)There are many dosage forms available for relieving hemorrhoid what they also what is the best one?

Ointment ,cream , suppositories, sprays but Cream ,oint., is superiors to suppositories, it may be bypass the affected area.Area must be washed by soap and dry before applied product.Question . 26Faculty of Pharmacy - Alexandria University (Egypt)I heard that there are varieties of OTC drugs used for ttt of hemorrhoid what are the possible class they belongs to ?giving Ex from Egypt markets.

Question . 27Faculty of Pharmacy - Alexandria University (Egypt)Active ingredientDosage formTrade nameZno ,bisthmus subgallate balsam peru,bisthmus oxideSupp,ontAnusol balsam peru :is demulcentbisthmus oxide,bisthmus subgallate: are astringent

Faculty of Pharmacy - Alexandria University (Egypt)Policresulen, cinchocaine Supp,oint. Faktu Cinchocaine is an amide local anesthetic Policresulen is atopical haemostatic and antiseptic

Faculty of Pharmacy - Alexandria University (Egypt)Framycetine,esculin,hydrocortisone, bisthmus oxide Supp,cream Procto-4 Esculin:vasoprotective ,have capillary astengthening action Framycetine: is antibacterial to protect against bacterial infection

Faculty of Pharmacy - Alexandria University (Egypt)Tribenoids,lidocaine Supp,cream proctoglyvenol Tribenoids is vasoprotective

Faculty of Pharmacy - Alexandria University (Egypt)My friend usually feel pain during defecation as he suffers from hemorrhoids he start to use Lignocaine cream as pain relievers ,please tell me how to use it properly ?

Question . 28Faculty of Pharmacy - Alexandria University (Egypt)It is local anesthetics used for pain , itching ,burning in the perianal region or lower anal canal (not in rectum ) as no sensory pain receptors .Must not to be applied to abraded skin as this will increase absorption systemically.Not to be used for more than seven days.Faculty of Pharmacy - Alexandria University (Egypt)My brothers defecation bloody ,can he take H-formula cream for his condition ,what is the role of shark liver oil in this product?Question . 29

Faculty of Pharmacy - Alexandria University (Egypt)Yes, he can take it until he have normal blood pressure ,no cardiac problems ,no thyroid gland problems.As H-formula contain phenyl ephedrine which is vasoconstrictors.


Shark liver oilShark liver oil is natural source of vitamin A which is promotes wound healing and tissues repair ,relieves symptoms accompanying .It act as emollient and protectant that provides physical barriers to irritation by forming protective layers over mucos membrane and anal region by preventing excessive water loss from tissue .Faculty of Pharmacy - Alexandria University (Egypt)I am suffering from sever irritation and inflammation in the preanal area which is the best form my condition . Anusol , or Anusol-HC Oint. ?Question . 30Faculty of Pharmacy - Alexandria University (Egypt)Anusol-HC is best . because it have hydrocortisone which ttt sever irritation and inflammation but it mask fungal , bacterial infection.


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