Management of Constipation in Adlts便秘的人管理.pptVIP

Management of Constipation in Adults Stephen Aglubat, MD May 2012 Objectives Define Constipation Treatment options for constipation Case 76 year old female with PMHx of HTN, DMII, HLD, presents to the clinic. She’s complaining of having stools only twice a week, and feeling “full.” She’s eating more vegetables, started drinking more water, and she recently included Metamucil to her diet. Her last colonoscopy one year ago was clean. She comes to your office to be evaluated for her constipation. What would you offer her for the constipation? A. Lactulose B. Senna C. Docusate D. Weekly tap water enemas Definition Rome III criteria: 2 of the below defines constipation Straining Lumpy Hard Stools Incomplete Evacuation Use of Digital Rectal Maneuvers Sensation of Anorectal Blockage 3 Bowel Movements per week Pathophysiology I Constipation is caused by: Primary Colorectal dysfunction Slow Transit Dyssnerygic Defacation Irritable Bowel Syndrome Pathophysiology II Constipation is caused by: Secondary Causes Endocrine/Metabolic Neurologic Myogenic Disorders Medications Obstruction Chronic Idiopathic Constipation (CIC) Management Initial treatment of Chronic Functional Constipation Lifestyle modification Diet and fiber Lifestyle Modifications Increased fluid intake Exercise Establish regular bowel regimen pattern Diet and fiber Fiber increases bulk/distension Distention causes stool propulsion. 25 g of fiber/day Effect may take weeks. Adverse effects: Bloating, flatulence Laxatives I Stimulant Laxatives Senna Bisacodyl Laxatives II Bulk forming laxatives Psyllium (Metamucil) Methylcellulose (Citrucel) Polycarbophil (FiberCon) Dextran (Benefiber) Laxatives III Osmotic Laxatives Polyethylene glycol Lactulose Sorbitol Magnesium Hydroxide Other therapies Colonic secretagogues Lubipristone Summary Constipation in the older adult may be due to chronic constipation, secondary etiologic factors A thorough history must be obtained to rule out secondary causes. Therapy includes: Di