2017 HCHB_digital

Constipation
Constipation is the term used to describe difficulty or infrequency in passing
faeces (poo). A person with constipation goes to the toilet to pass faeces less
often than normal for them, and their faeces are hard, small, and usually a strain
to pass. It is important to realise that not everybody has a daily bowel motion; it
may be natural for some people to go every second or third day, so the passage
of time between bowel motions before constipation occurs varies from individual
to individual.
The most common reasons for constipation are:
• being immobile – forced bedrest or disability
• dehydration – drinking too little fluid, vomiting or excessive sweating
• diet – eating too little, or eating low bulk or milky foods
• pain or other medical conditions (eg, Parkinson’s disease, irritable bowel
syndrome)
• pregnancy
• medicines such as diuretics, iron supplements, and opioid pain relievers.
People with no apparent reason for their constipation should be referred to a
doctor for further advice if it persists. Some people are found to have a generally
underactive bowel, and may need long-term laxatives prescribed.
Occasionally, some people complaining of diarrhoea may in fact have
“overflow” diarrhoea as a result of severe constipation (refer to a pharmacist).
People who suffer from constipation may also complain of stomach cramps,
frequent passing of wind (flatulence) or bloating. Haemorrhoids can also occur
with constipation as a result of straining when passing a bowel motion (see
Haemorrhoids).
Initial assessment
Observe how your customer holds themselves – are they doubled over with
stomach cramps or is their mobility limited? Do they look well hydrated or does
their skin appear dry? Could they possibly be pregnant?
It is important to identify which customers you need to refer to the pharmacist
as some products may not be suitable for them.
Treatment
Products used to treat constipation are called laxatives and several different
types are available. Most need to be given on a regular basis and some take
up to three days to work properly (see Treatment options for more information).
Advice for customers
• Fibre is important for our health, and a high-fibre diet should be recommended
for most people, although it may not be appropriate for the very young or very
old.
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Wholegrain breads and cereals, nuts, beans, lentils, fresh and dried fruits
(not fruit juices) and vegetables are high in fibre.
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Men should aim for around 30g/day of fibre and women 25g/day.
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Children aged between four and 18 need only slightly less than adults
(about 18–28g/day).
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the sufferer a baby or young child?
• Has the constipation continued for longer than seven days?
• Is there any vomiting?
• Has the customer lost any weight?
• Are the bowel motions dark and tarry-looking or contain blood?
• Has the constipation been recurrent, persistent or is worsening?
• Is there any abdominal pain or bloating?
• Has the person been buying or using large amounts of laxatives?
• Does the constipation alternate with diarrhoea?
• Does the person have a fever?
• Does the person have any allergies to medicines?
Refer also if you suspect laxatives are being abused, perhaps as a
method of losing weight.
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Increase fibre intake once the current constipation problem has resolved.
• Regular exercise and sufficient fluid intake – at least six glasses of water a
day – also prevents constipation.
• Avoid long-term use of stimulant laxatives unless under medical advice.
• Seek medical advice if problems with bowel motions persist.
• Don’t put off going to the toilet if you feel the urge as this can lead to
constipation or make it worse.
• Remind the customer that not everyone has a daily bowel motion and offer
advice about haemorrhoids (see Haemorrhoids) if these are also present.
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Page 38 HEALTHCARE HANDBOOK 2017-2018 Common Disorders