1.

Digestive System
The digestive system is a series of hollow organs joined in I long twisting
tube from the mouth to the anus
The process starts when food is chewed and swallowed then passes form
the mouth into the oesophagus there it is pushed on to the stomach where
the food mixes with digestive juices it is churned and mixed up before it is
slowly released in to the small intestine. The food will then dissolve further
as juices from the pancreas and the liver are mixed together with the food.
Once the small intestine has absorbed all the nutrients form the food it
passes on to the large intestine.

The large intestine as well as acting as a passage way for the removal of
body waste it acts as a provisional reservoir for water. As water is absorbed
the contents of the large intestine changes from watery liquid to semi solid
faeces. The faeces moves down through the colon into the rectum and out
through the anus when the brain send s a signal to indicate that its time to
empty the rectum.

Questions
2. The bowels act as a receptacle for body waste.

3. A normal bowel habit can be described as a person havening a bowel

movement between 2-3 times a day or 2-3 times a week.

4. Constipation is a decrease in the frequency and amount of an

individuals usual bowel action, which is usually associated with the
difficulty and sometimes painful passage of hard, dry pellet shaped
stools which may be followed by a feeling of incomplete emptying.

5. The symptoms of constipation can be-

• Altered bowel habit
• Infrequent hard pellet like stools
• Feeling of incomplete evacuation
• Abdominal pain
• Flatulence/bloating
• Nausea/vomiting
• Urinary dysfunction
• Poor appetite
• Malaise
Any one or a combination of these can cause constipation.

6 Simple constipation is usually related to diet, fluid, lifestyle, any of

these or a combination can cause constipation.

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 7 Secondary constipation is usually linked to a disease, medical condition
or drug therapy.

8 Chronic constipation can be described as being constipated on a

regular basis and never having a normal bowel movement.

9 Patient groups that can present with chronic constipation are the
elderly and infirm, due to poor mobility inability to prepare nutritious
food and lack of exercise can put them at risk. Pregnancy can cause
constipation due to the increased size of the uterus and increased
levels of progesterone, which reduces colonic activity. Young children
can present with chronic constipation due to poor appetite, lack of
fluids throughout the day especially in school aged children who can
be restricted in what they drink and also their fear of using school
toilets or any toilet other than their home toilet.
Patients that are ill can become chronically constipated due to poor
appetite, medication or simply by being bed bound.

10 Drugs that may cause constipation are:-

Drug Family Most Common Use
Antacids (aluminium) Relieve heartburn
Anti cholinergics Relieving symptoms of
Parkinson's, treat
depression, anxiety,
and nervousness
Anticonvulsants Control epilepsy and
other seizure disorders
Antidepressants Treat symptoms of
depression
Anti hypertensives Lower blood pressure
Anti psychotics Treat symptoms of
certain psychosis
Bild acid Reduce cholesterol
sequestrants
Calcium Supplement dietary
supplements(3) calcium
Diuretics Fluid retension
Iron Supplements Iron deficiency or
anemia
Opiates Pain relievers

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Constipation can be caused by a variety of medications. These medications
affect the nerve and muscle activity in the large intestine (colon) and may
also bind intestinal liquid. This may result in slowed colonic action (slow
and/or difficult passing of stool).

Drugs which may cause diarrhoea include:

Antacids (Magnesium)

Antibiotics

Antidepressants

Beta Blockers

Diuretics

Iron preparations

Hypoglycaemic preparations (Sorbital)

11 Osmotic agents can work to relive constipation by helping retain fluid

in the large bowel by osmosis or by changing the pattern of water
distribution in the gut. In other words hydrate the stool to make an easier
passage from the rectum to the anus.

Stool softeners lower the surface tension of the colonic contents. They
allow fat and fluid to break through and soften the faeces. They can also
stimulate the bowel. They provide moisture to the stool and prevent
excessive loss of water.

Bulking agents will increase the faecal mass by adding volume to the colonic
contents.

Stimulant laxatives cause rhythmic muscular contractions in the intestines.

Lubricants can help by making the anus and rectum moist to aid the passage
of the stool. Examples of this are KY jelly, or any lubricating enema that will
help stimulate a bowel movement. Also oral preparations can lubricate the
process.

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12 Bulk forming drugs = Examples of these are Bran, Isphagula, Bran
Sterculia, Methylcelullose.

Stimulants = Examples of these are Bisacody , Senna,

Docusate.

Osmotic = Examples of these are Lactulose, Magnesium

hydroxide, Movicol.

Stool softening agents Examples of these are Arachis Oil, Liquid

Paraffin, Decusate.

Rectal preparations Phosphate enema, Glycerin suppositories

13 Bulk forming agents increase faecal mass by adding volume, and by

acting as a transmitter to aid bacteria, which adds to the overall
faecal mass.

Stimulants increase intestinal movement by sending peristaltic

waves to encourage a bowel movement.

Lactulose acts by speeding up the passage of the stool through the

large intestine, this allows less water to be absorbed by the body
so the faces becomes more liquid and is passed more easily.

Stool softening agents ease the passage of the stool by softening

it and lubricating the anus to aid defecation. They allow fat and
fluid to penetrate and soften the faeces. they can also act as a
stimulant.

Rectal preparation help clear the bowel, these can aid in the
preparation for surgery or further investigations.

14 An ideal bowel movement can be defined as passing a semi-solid stool

with a soft consistency, with no urgency or straining.

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15 Facts

10% of the populations are affected by constipation.

25% of the elderly are affected by constipation

Constipation is more prevalent in women.

Only 13 consultants out of 1000 have expertise in the field of constipation.

Up to 73% of patients on long stay wards are prescribed laxatives.

16 Constipation can be defined as a decrease in the frequency and

amount of an individuals usual bowel action, which is usually associated
with the difficulty and sometimes painful passage of hard, dry, pellet
shaped stools which may be followed by a feeling of incomplete
emptying.

17 Some of the causes of simple constipation are –poor diet lack of fluid
and or fibre. Avoiding or ignoring the signals to go to the toilet. Lack
of exercise. Old age can be a contributing factor in that elderly tend
to be less active, can reduce their food and fluid intake due to ill
health or decreased mobility.

18 Causes of secondary constipation can be diseases of the bowel,

neurological disorders such as Parkinson or spinal disorders, some
procedures such as barium studies can cause constipation, also some
drugs can lead to constipation for example opioids, or iron.

19 The effects of secondary constipation can be the slow decent of food

through the gut causing the contents to remain longer and allowing
more fluid to be absorbed causing harder stools to form.

20 Many things can affect the bowel such as changes in morning routine,
reducing fluid and fibre in you diet, the lack of exercise. Emotions can
have an affect on your bowel by either making you constipated or have
diarrhoea.

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21 A person’s quality of life can be affected by constipation by causing
depression, pain bloating feeling generally unwell. People can often
become irritable due to pain it can also have an effect on mobility.

22 Complications that can be associated with constipation Haemorrhoids,

this can happen due to continuous straining. Faecal impaction and
urinary incontinence is also a complication of constipation. It can also
cause diverticular disease.

23 Faecal impaction can be defined as a mass of compressed faeces in

the rectum, colon. This is one of the main complications of
constipation.

24 Faecal impaction can be cause by a number of things. Underlying

diseases can be the cause such as Neurological, Renal disease,
Diabetes, Hypothyroidism or Cardiovascular disease. Confusion and
depression can also cause faecal impaction due to the patient not
being aware that they need to go or being so depressed that they
don’t care. Fluid and diet restrictions can impact faecal impaction.
Poor mobility and lack of exercise can also cause this. One other cause
is due to the abuse of laxatives.

25 Patients with Neurological diseases, the elderly and patients with

dementia or depression are the most likely to be affected. Also
patients with disabilities are prone to faecal impaction.

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26 Bowel Management
Some self help measures that can be put in place are changing your fluid and
diet intake. Positioning yourself on the toilet properly, not perching or
hovering, but sitting firmly on the seat. By making time to use the toilet and
not rushing. By adding some form of exercise in to your routine.

Mechanical measure that can be put in place are having abdominal massages,
digital stimulation to re educate the bowel, suppositories or enemas can be
given to help stimulate the bowel and so encourage the passage of the stool.
Manual and surgical removal are usually done when all else fails as these are
very invasive methods.

Lifestyle changes can be implemented by changing routine education in the

benefit of fluids and fibre in the diet. Exercising, even if it’s only a walk
every day. Making sure the bathroom is private and accessible.

Recommending that the patient has at least 24 grams of fibre a day and
that their fluid intake is between 1-2 litres a day. Also explaining the
importance of 5 portions of fruit and vegetables per day.

27 Fibre content in food-

Bread Grams Vegetables
White slice 0.5 Baked beans 5
Wholemeal slice 2 Lettuce 0.2
Brown Peas canned 4.1
Breakfast cereals Potatoes jacket 1.4
All bran 10 Potatoes boiled 1
Cornflakes 0.2 Sprouts 4.8
Porridge 2 Biscuits
Weetabix 2 Digestives 0.6
Fruit Oatcakes 1.5
Apple 2 Cake
Banana 1 Rich fruit cake 1
Blackberries 3.1 Sponge 0.5
Orange 1 Nuts
Pear 3 All nuts 2
Rice/pasta
Brown rice 1.5

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Pasta 2
White rice 0.5
Wholemeal pasta 5

28 Fibre is both soluble and insoluble.

The difference between the two are that soluble fibre is effectively broken
down by enzyme producing bacteria present in the colon to produce energy
and gas and bulky stools. Insoluble fibre is less easily broken down by
bacteria in the colon, but can hold water which helps to increase the stool
weight.
Foods high in soluble fibre are-
Fruit
Vegetables/pulses (e.g. peas beans)
Oats
Barley
Seeds
Foods high in insoluble fibre are-
Fruit and vegetables with their skins on
Wholegrain cereals (wheat, rye, rice)
Nuts and some pulses

29 What measures can be implemented on:-

Bowel habit –re- education
Toilet training –get a routine make time and make sure you have privacy
Diet – change your dietary habits increase fluids and fruit and vegetables
Exercise- try some form of exercise, incorporate in to daily life style.

30 What symptoms may lead you to consider underlying disease?

• Blood
• Pain
• Mucus
• Sudden weight loss
• Changes in normal bowel habit (become constipated or develop loose
stools)

31 What might cause severe diarrhoea?

• Infection
• Food poisoning
• Bowel disease
• Misuse of laxatives
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 • Medication
• Alcohol/Drugs

32 Crohn's disease causes inflammation in the small intestine. Crohn's

disease usually occurs in the lower part of the small intestine, called
the ileum, but it can affect any part of the digestive tract, from the
mouth to the anus. The inflammation extends deep into the lining of
the affected organ. The inflammation can cause pain and can make the
intestines empty frequently, resulting in diarrhoea.

Ulcerative colitis is a disease that causes inflammation and sores,

called ulcers, in the lining of the large intestine. The inflammation
usually occurs in the rectum and lower part of the colon, but it may
affect the entire colon. Ulcerative colitis rarely affects the small
intestine except for the end section, called the terminal ileum.
Ulcerative colitis may also be called colitis or proctitis.

The inflammation makes the colon empty frequently, causing

diarrhoea. Ulcers form in places where the inflammation has killed the
cells lining the colon; the ulcers bleed and produce pus.

Diverticular disease is the formation of small pouches (diverticula) in

the colon. When these are not inflamed or irritated, the condition is
called diverticulosis. If the diverticula become infected or irritated,
diverticulitis develops.

Irritable Bowel Syndrome is not a disease. It's a functional disorder,

which means that the bowel doesn't work as it should.

With IBS, the nerves and muscles in the bowel are extra-sensitive.
For example, the muscles may contract too much when you eat. These
contractions can cause cramping and diarrhoea during or shortly after
a meal. Or the nerves can be overly sensitive to the stretching of the
bowel (because of gas, for example). Cramping or pain can result.

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 33 Diminished rectal distension occurs in the elderly due to

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