intestinal gas and constipation

what can cause increased intestinal gas

aerophagia (air swallowing)

foods

medical conditions

medications

what foods can cause increased intestinal gas

sugars

high-fiber foods

vegetables

carbonated beverages

what are medical conditions associated with intestinal gas

lactase deficiency

bacterial overgrowth in the small intestine

bowel disorders

how can medications cause intestinal gas

affect intestinal flora

affect metabolism of glucose or dietary substances

affect GI motility

contain or release gas

contain fiber

contain lactose or gluten

what are signs and symptoms of intestinal gas

eructation

bloating

flatulence

abdominal cramping or discomfort

nausea

audible bowel sounds

dyspepsia/indigestion

what are the exclusions to self care for intestinal gas

symptoms persist for several days or occur several times a month

severe, debilitating symptoms

sudden and significant change in location, frequency, or severity of abdominal pain

onset of symptoms in patients over 40

symptoms accompanied by significant abdominal pain or a sudden change in bowel function

severe or persistent diarrhea or constipation, GI bleeding, fatigue, unintentional weight loss, or frequent nocturnal symptoms

what are nonpharm treatments for intestinal gas

discuss the relationship between eating habits, diet, and intestinal gas

avoid foods known to increase gas production

assess for lactase deficiency or gluten intolerance

lifestyle modifications

what are the pharmacologic options for intestinal gas

simethicone

activated charcoal

alpha-galactosidase

lactase

what is the mechanism for simethicone

defoaming agent that reduces the surface tension of gas bubbles in the GI tract

what are contraindications for simethicone

hypersensitivity to simethicone

intestinal perforation

intestinal obstruction

when should a patient using simethicone be referred

if no improvement is noted within 24 hours

what is the proposed mechanism of activated charcoal

adsorb and potentiate its removal — possibly helpful in reducing sulfur-based, odorous gases

what is the mechanism of alpha-galactosidase

hydrolyzes oligosaccharides before bacteria in the colon metabolize them and produce gas

what patients should be monitored when using alpha-galactosidase

patients with diabetes, galactosemia, and mold allergies

what is the mechanism of lactase replacement

allows the breakdown of lactose to glucose and galactose

what are alternative therapies for intestinal gas

probiotics

fennel and mint

what are the FDA approved options for intestinal gas

simethicone and alpha-galactosidase

when should a patient with intestinal gas be referred

if no improvement within 24 hours

what is constipation

fewer than 3 bowel movements per week

what will a patient with constipation describe

straining to have a bowel movement

hard, dry stools

small stools

feeling of incomplete bowel evacuation

decreased stool frequency

what are the complications of constipation

hemorrhoids

anal fissures

rectal prolapse

fecal impaction

what are primary causes of constipation

slower movement through the GI tract

muscle disorders

what are secondary causes of constipation

systemic abnormalities

neurological changes

psychological disorders

what are the signs and symptoms of constipation

decreased stool frequency, difficulty passing stool

anorexia

dull headache

fatigue

low back pain, abdominal discomfort

bloating, flatulence

psychosocial distress

what are the exclusions to care for constipation

marked abdominal pain or significant distention or cramping

marked/unexplained flatulence

fever, nausea, vomiting

chronic medical condition that may prevent laxative use

daily laxative use

unexplained change in bowel habits

blood in stool or dark/tarry stool

marked change in characteristics of stool

bowel symptoms lasting >2 weeks or recur over 3 months

bowel symptoms that recur after dietary/lifestyle changes or use of laxatives

IBS

anorexia

<2 years

what are nonpharm therapies for constipation

balanced diet

fiber supplements

adequate hydration

bowel training

physical activity

what are the pharmacologic therapies for constipation

bulk-forming agents

hyperosmotic agents

emollient agents

lubricants

saline laxatives

stimulant laxatives

what are the components of bulk-forming agents

methylcellulose

calcium polycarbophil

psyllium

what is the onset of bulk forming agents

12-24 hours

what patient populations use bulk forming agents

patients on low fiber diets

postpartum women

older adults

patients with colostomies, IBS, or diverticular disease

what are the adverse effects of bulk forming agents

abdominal cramping/flatulence

avoid in patients with intestinal ulceration or stenosis

avoid in patients with swallowing difficulties or fluid restrictions

what is the mechanism for hyperosmotic agents

pull water into the colon through osmosis to stimulate bowel movement

what is the brand name of PEG 3350

miralax

what patient population is miralax approved for

patients >17 years

how is miralax administered

17 grams of powder in 4-8 ounces of water

what are the adverse effects of miralax

bloating

abdominal discomfort

cramping

flatulence

what is the onset of miralax

12-72 hours

what is the onset of glycerin suppositories

15-30 minutes

what product is an emollient

docusate

what is the mechanism of emollients

acts as a surfactant which increases the wetting efficiency and results in softer stools

what is the onset of emollients

12-72 hours

what product is a lubricant

mineral oil

what is the mechanism of mineral oil

soften fecal content by coating stool, preventing water absorption by the colon

what is the onset of oral mineral oil

6-8 hours

what is the onset of rectal mineral oil

5-15 minutes

what are the adverse effects of mineral oil

oil leakage from anal sphincter

oil deposits in lymph nodes, liver, intestinal mucosa, and spleen

what products are saline laxatives

magnesium citrate

magnesium hydroxide

dibasic and monobasic sodium phosphate

what is the mechanism of saline laxatives

draw water into the small and large intestines by osmosis, increasing intraluminal pressure and motility within the intestine

what are saline laxatives used for

treat constipation

acute bowel evacuation before a procedure (colonscopy)

what is the onset of oral saline laxatives

0.5-3 hours

what is the onset of rectal saline laxatives

2-15 minutes

what are the adverse effects of saline laxatives

abdominal cramping

nausea, vomiting

dehydration

what is the mechanism of stimulant laxatives

increase intestinal motility within the colon

what products are stimulant laxatives

bisacodyl

senna

what is the brand name of bisacodyl

dulcolax

what is the brand name for senna

senokot

what is the onset of oral bisacodyl

6-10 hours

what is the onset of bisacodyl suppositories

15-60 minutes

what is the onset of senna

6-10 hours

what are the adverse effects of stimulant laxatives

nausea, vomiting, diarrhea

severe cramping

electrolyte and fluid loss

abdominal pain

what are alternative therapies for constipation

flaxseed

aloe

cascara

probiotics

what is constipation in children

delay or difficulty in achieving bowel movements over a 2 week period or longer

what should be done first when treating constipation in a child

address underlying causes and recommend dietary modifications

what medication should be used in children 2-6 years with constipation

oral docusate or magnesium hydroxide

what medications should be used in children 6-12 years for constipation

bulk-forming agents, docusate sodium, or magnesium hydroxide

what dietary modifications are recommended for children

increase sorbitol consumption through fruit juice

high fiber diet — grains, veggies, fruits — age + 5g/day

what therapy should be considered first for elderly patients

lifestyle modifications — increase fiber and fluid, consume prunes or prune juice, increase physical activity

what are considered first line therapy for elderly

bulk forming laxatives or miralax if bulk forming is contraindicated

what therapies should be avoided in elderly

mineral oil

saline laxatives

what are the therapy options for constipation in pregnant women

dietary measures — first line

bulk forming laxatives

docusate

senna/bisacodyl/PEG 3350

what therapies should be avoided in pregnancy/lactation

castor oil

mineral oil

saline laxatives

when should patients be referred after self treatment for constipation

if constipation persists at 7 days of treatment or if complications occur