DOCSLIB.ORG

Final Stakeholder List PDF 190 KB

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Final Stakeholder List PDF 190 KB Appendix C NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Single Technology Appraisal Naldemedine for treating opioid-induced constipation [ID1189] Matrix of consultees and commentators Consultees Commentators (no right to submit or appeal) Company General • Shionogi (naldemedine) • All Wales Therapeutics and Toxicology Centre Patient/carer groups • Allied Health Professionals Federation • Action on Pain • Board of Community Health Councils in • Black Health Agency Wales • Bladder and Bowel Community • British National Formulary • Bladder and Bowel UK • Care Quality Commission • Cancer Black Care • Department of Health, Social Services • Cancer Equality and Public Safety for Northern Ireland • Guts UK • Healthcare Improvement Scotland • HAWC • Medicines and Healthcare products • Helen Rollason Cancer Charity Regulatory Agency • IBS Network • National Association of Primary Care • Independent Cancer Patients Voice • National Pharmacy Association • Macmillan Cancer Support • NHS Alliance • Maggie’s Centres • NHS Confederation • Marie Curie • Scottish Medicines Consortium • Muslim Council of Britain • Scottish Society of Gastroenterology • Pain Concern • Welsh Health Specialised Services • Pain Relief Foundation Committee • Pain UK • South Asian Health Foundation Possible comparator companies • Specialised Healthcare Alliance • Actavis UK (glycerol suppositories, • Tenovus Cancer Care bisacodyl, lactulose, senna) • Wellbeing of Women • Cardinal Health Martindale Products • Women’s Health Concern (glycerol suppositories) • Concordia International Professional groups (methylcellulose) • Association for Continence Advice • Dr. Reddy’s lab (bisacodyl) • Association of Cancer Physicians • Hermal (ispaghula husk, glycerol • Association of Coloproctology of Great suppositories) Britain and Ireland • Intrapharma (lactulose) • British Geriatrics Society • Kyowa Kirin (naloxegol) • British Psychosocial Oncology Society • Laboratorios Casen Fleet (sodium • British Society of Gastroenterology dihydrogen phosphate dehydrate, disodium hydrogen phosphate National Institute for Health and Care Excellence Matrix for the technology appraisal of naldemedine for treating opioid-induced constipation [ID1189] Issue date: April 2019 Page 1 of 4 Appendix C Consultees Commentators (no right to submit or appeal) • Cancer Research UK dodecahydrate enema) • Primary Care Society for • Meda Pharmaceuticals (macrogol, Gastroenterology senna) • Royal College of General Practitioners • Mylan products (lactulose) • Royal College of Nursing • Napp Pharmaceuticals (naloxone- • Royal College of Pathologists oxycodone) • Royal College of Physicians • Norgine Pharmaceuticals (sterculia/ • Royal Pharmaceutical Society frangula, macrogol, docusate sodium • Royal Society of Medicine enema) • UK Clinical Pharmacy Association • Novartis (senna) • UK Continence Society • Orbis Consumer Products (glycerol • UK Health Forum suppositories) • UK Oncology Nursing Society • Pinewood Healthcare (sodium citrate enema) Others • Reckitt Benckiser Healthcare (senna) • Department of Health • Sandoz (lactulose) • NHS Brighton & Hove CCG • Sanofi (bisacodyl, docusate, macrogol • NHS England sodium picosulfate) • NHS North Hampshire CCG • Stirling Anglian (macrogol) • Welsh Government • Swedish Orphan Biovitrum (methylnaltrexone bromide) • Teva UK (lactulose) • Thornton & Ross (macrogol, magnesium hydroxide, glycerol suppositories, senna) • UCB Pharma (sodium citrate enema, docusate) Relevant research groups • Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group • Institute of Cancer Research • MRC Clinical Trials Unit • National Cancer Research Institute • National Cancer Research Network • National Institute for Health Research Associated Public Health groups • Public Health England • Public Health Wales National Institute for Health and Care Excellence Matrix for the technology appraisal of naldemedine for treating opioid-induced constipation [ID1189] Issue date: April 2019 Page 2 of 4 Appendix C NICE is committed to promoting equality, eliminating unlawful discrimination and fostering good relations between people who share a protected characteristic and those who do not. Please let us know if we have missed any important organisations from the lists in the matrix, and which organisations we should include that have a particular focus on relevant equality issues. PTO FOR DEFINITIONS OF CONSULTEES AND COMMENTATORS National Institute for Health and Care Excellence Matrix for the technology appraisal of naldemedine for treating opioid-induced constipation [ID1189] Issue date: April 2019 Page 3 of 4 Appendix C Definitions: Consultees Organisations that accept an invitation to participate in the appraisal; the company that markets the technology; national professional organisations; national patient organisations; the Department of Health and the Welsh Government and relevant NHS organisations in England. The company that markets the technology is invited to make an evidence submission, respond to consultations, nominate clinical specialists and has the right to appeal against the Final Appraisal Determination (FAD). All non-company consultees are invited to submit a statement1, respond to consultations, nominate clinical specialists or patient experts and have the right to appeal against the Final Appraisal Determination (FAD). Commentators Organisations that engage in the appraisal process but that are not asked to prepare an evidence submission or statement, are able to respond to consultations and they receive the FAD for information only, without right of appeal. These organisations are: companies that market comparator technologies; Healthcare Improvement Scotland; other related research groups where appropriate (for example, the Medical Research Council [MRC], National Cancer Research Institute); other groups (for example, the NHS Confederation, NHS Alliance and NHS Commercial Medicines Unit, and the British National Formulary. All non-company commentators are invited to nominate clinical specialists or patient experts. 1 Non-company consultees are invited to submit statements relevant to the group they are representing. National Institute for Health and Care Excellence Matrix for the technology appraisal of naldemedine for treating opioid-induced constipation [ID1189] Issue date: April 2019 Page 4 of 4 .
Load more

Recommended publications
  • Laxatives for the Management of Constipation in People Receiving Palliative Care (Review)
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by UCL Discovery Laxatives for the management of constipation in people receiving palliative care (Review) Candy B, Jones L, Larkin PJ, Vickerstaff V, Tookman A, Stone P This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2015, Issue 5 http://www.thecochranelibrary.com Laxatives for the management of constipation in people receiving palliative care (Review) Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 4 METHODS ...................................... 4 RESULTS....................................... 7 Figure1. ..................................... 8 Figure2. ..................................... 9 Figure3. ..................................... 10 DISCUSSION ..................................... 13 AUTHORS’CONCLUSIONS . 14 ACKNOWLEDGEMENTS . 14 REFERENCES ..................................... 15 CHARACTERISTICSOFSTUDIES . 17 DATAANDANALYSES. 26 ADDITIONALTABLES. 26 APPENDICES ..................................... 28 WHAT’SNEW..................................... 35 HISTORY....................................... 35 CONTRIBUTIONSOFAUTHORS . 36 DECLARATIONSOFINTEREST . 36 SOURCESOFSUPPORT . 36 DIFFERENCES
    [Show full text]
  • Immediate Hypersensitivity Reactions Caused by Drug Excipients: a Literature Review Caballero ML, Quirce S
    REVIEWS Immediate Hypersensitivity Reactions Caused by Drug Excipients: A Literature Review Caballero ML, Quirce S Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain J Investig Allergol Clin Immunol 2020; Vol. 30(2): 86-100 doi: 10.18176/jiaci.0476 Abstract The European Medicines Agency defines excipients as the constituents of a pharmaceutical form apart from the active substance. Immediate hypersensitivity reactions (IHRs) caused by excipients contained in the formulation of medications have been described. However, there are no data on the prevalence of IHRs due to drug excipients. Clinical manifestations of allergy to excipients can range from skin disorders to life-threatening systemic reactions. The aim of this study was to review the literature on allergy to pharmaceutical excipients and to record the IHRs described with various types of medications, specifically reactions due to the excipients contained in their formulations. The cases reported were sorted alphabetically by type of medication and excipient in order to obtain a list of the excipients most frequently involved for each type of medication. Key words: Allergy. Drug immediate hypersensitivity reaction. Excipient. Pharmaceutical excipients. Resumen La Agencia Europea de Medicamentos define los excipientes como los componentes de una forma farmacéutica diferenciados del principio activo. Se han descrito reacciones de hipersensibilidad inmediata causadas por los excipientes contenidos en la formulación de medicamentos. Sin embargo, no hay datos sobre la prevalencia de dichas reacciones. Las manifestaciones clínicas de la alergia a los excipientes pueden ir desde trastornos de la piel hasta reacciones sistémicas que ponen en peligro la vida. El objetivo de este estudio fue realizar una revisión de la literatura sobre la alergia a los excipientes farmacéuticos y recopilar las reacciones inmediatas descritas con diferentes tipos de medicamento, debido solo a excipientes contenidos en sus formulaciones.
    [Show full text]
  • Prucalopride for the Treatment of Chronic Constipation in Women
    Prucalopride for the Treatment of Chronic Constipation in Women: Single Technology Appraisal Response to consultation from Norgine Pharmaceuticals Ltd Comments on clinical assessment 1. The ICER for prucalopride of around £15,000 to £17,000 per QALY gained, whilst probably acceptable for an innovative medicine for a serious or life- threatening condition, is far in excess of what should be considered as acceptable for a laxative. As far as providing value for the NHS is concerned the ICER for Norgine‟s macrogol laxative Movicol is estimated at £250 per QALY gained1, which clearly provides much better value for money. Norgine would therefore question whether prucalopride should be recommended at all by NICE for use in the NHS in England and Wales. 2. If it is considered that prucalopride is cost-effective for use in the NHS in England and Wales, then the preliminary recommendations of the Advisory Committee are not sufficiently precise to avoid doubt as to what the guidance is intended to recommend. For example: (i) It is not clear what is meant by “a clinician with experience of treating chronic constipation.” Many clinicians treat chronic constipation and in numerical terms, nurses probably are involved to a greater extent in managing this condition in primary care than are doctors, and as a result probably have more experience in treating chronic constipation than do primary care physicians. Not all gastroenterologists in secondary care would necessarily qualify as experienced in treating chronic constipation, unless they specialise in the functional bowel disorders. Therefore we would suggest that initially at least the guidance should state that prucalopride therapy should only be initiated by a secondary care physician specialising in the treatment of the functional bowel disorders.
    [Show full text]
  • Drugs Used in Treating Constipation and IBS
    Drugs used in treating constipation and IBS Define constipation Know the different symptoms of constipation Know the different lines of treatment of constipation Identify the different types of laxatives Discuss the pharmacokinetics, dynamics, side effects and uses of laxatives Discuss the difference between different treatment including bulk forming laxatives, osmotic laxatives, stimulant laxatives And stool softeners (lubricants). Define bowel syndrome (IBS). Identify the pharmacokinetics, dynamics, side effects and uses of drugs used for IBS. extra information and further explanation important doctors notes Drugs names Mnemonics Kindly check the editing file before studying this document constipation and IBS Very useful. Don’t miss it Infrequent defecation, often with straining and the passage of hard, uncomfortable stools. - May be accompanied by other symptoms: Abdominal discomfort and rectal pain, Flatulence, Loss of appetite, Lethargy & Depression. Decreased motility in colon: Decrease in water and fiber Difficulty in evacuation: Drug-induced: contents of diet. 1. Local painful conditions: 1. Anticholinergic agents “Unbalanced diet” anal fissures, piles. 2. Opioids 2. Lack of muscular 3. Iron exercise. 4. Antipsychotics. 5. Anti-depressant, anti- histamine, has anticholinergic effect Adequate fluid intake High fiber contents in diet Use drugs (laxatives or Regulation of bowel habit. purgatives more watery effect) Regular exercise Avoid drugs causing constipation. • Drugs that hasten the transit of food through the gastrointestinal tract are called (Or we say the drugs that increase GI motility) (محركات) or purgatives(ملينات) laxatives • Loosen stools and increase bowel movement Bulk forming laxatives (increase the size of stool ) • Increase volume of non-absorbable solid residue. Osmotic laxatives (cause water withdrawal by sugar or salt) • Increase water content in large intestine.
    [Show full text]
  • Managing Opioid-Induced Constipation
    Visual summary MODIFY PAIN RELIEF Managing opioid-induced constipation Is the current dose of opioid needed to control pain? Constipation affects many patients using opioids Could pain be relieved in other ways? to relieve pain associated with advanced cancer Non-opioid analgesics Interventional pain management or terminal disease. Constipation is often multifactorial in such patients, Could an opioid with less constipating effect be used? and opioids may be one of several causes. As well Buprenorphine Transdermal fentanyl as direct treatment of the constipation, adjusting medication regimens and treating exacerbating factors may help to provide relief from bowel transit Is a referral to other specialists needed? symptoms. Palliative care Neuro-gastroenterology Pain clinic ADDRESS EXACERBATING FACTORS DIRECTLY TREAT CONSTIPATION Drugs Non-pharmacological options 5HT3 antagonists Anticholinergics Opioids Increase fluid consumption Increase dietary fibres Antipsychotics Diuretics Iron Increase physical activity (within patients’ capabilities) Calcium supplements Calcium channel blockers Privacy and comfort during defecation Chemotherapies Complementary therapy Thalidomide Vinca alkaloids Positioning on toilet (to relax the puborectalis muscle) knees higher than hips, leaning forward Busulfan Carboplatin with elbows on knees, straightened spine Manual removal Nutritional and if the constipation is severe and refractory to other therapies metabolic issues Pharmacological management Dehydration Reduced food and fluids intake Oral laxatives Poor
    [Show full text]
  • Treatment of Faecal Impaction in Children Using Combined
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of Groningen University of Groningen Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate Lamanna, Anthony; Dughetti, Lauren D.; Jordan-Ely, Julie A.; Dobson, Kyla M.; Dynan, Megan; Foo, Adeline; Kooiman, Louise M. P.; Murakami, Naomi; Fiuza, Kaic; Foroughi, Siavash Published in: BJGP open DOI: 10.1002/jgh3.12062 IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2018 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Lamanna, A., Dughetti, L. D., Jordan-Ely, J. A., Dobson, K. M., Dynan, M., Foo, A., ... Southwell, B. R. (2018). Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate. BJGP open, 2(4), 144-151. https://doi.org/10.1002/jgh3.12062 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal.
    [Show full text]
  • Compound Macrogol Oral Powder Sugar Free. Please Tell Your Doctor Or Pharmacist If You Are Taking, Have Recently Taken Or Might Take Any Other Medicines
    Package leaflet: Information for the user Compound Macrogol Oral Powder Sugar Free Read all of this leaflet carefully before you start taking this medicine because it contains important information for you. Always take this medicine exactly as described in this leaflet or as your doctor, pharmacist or nurse have told you. - Keep this leaflet. You may need to read it again. - Ask your pharmacist if you need more information or advice. - If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4. - You must talk to a doctor if you do not feel better or if you feel worse after 14 days for chronic constipation, or after 3 days for faecal impaction. What is in this leaflet: 1. What Compound Macrogol Oral Powder Sugar Free is and what it is used for 2. What you need to know before you take Compound Macrogol Oral Powder Sugar Free 3. How to take Compound Macrogol Oral Powder Sugar Free 4. Possible side effects 5. How to store Compound Macrogol Oral Powder Sugar Free 6. Contents of the pack and other information 1. What Compound Macrogol Oral Powder Sugar Free is and what it is used for Compound Macrogol Oral Powder Sugar Free contains macrogol 3350 and the electrolytes sodium chloride, sodium hydrogen carbonate and potassium chloride. Macrogol 3350 is a laxative used for the treatment of constipation, especially if you have been constipated for a long time. It is also used to treat a build up of hard faeces in your bowel which may be a result of long-term constipation (this is known as faecal impaction).
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • Constpation Refworks
    Guidelines for Management of Idiopathic Childhood Constipation Introduction • Constipation is common in childhood affecting up to 30% of the child population. Symptoms become chronic in more than one third of patients and constipation is a common reason for referral to secondary care. • ‘Idiopathic Constipation’ refers to constipation not explained by anatomical or physiological abnormalities. • A NICE guideline entitled ‘Diagnosis and management of idiopathic childhood constipation in primary and secondary care’ was published in 2010 and the RHSC paediatric department endorses its approach. Key steps are to: 1) Identify symptoms of constipation and faecal impaction through history and physical examination 2) Recognise features in history / examination indicative of alternative underlying pathology (termed red and amber flags) 3) Provide advice on diagnosis 4) Prescribe and supervise a disimpaction regimen (where evidence of faecal impaction exists) followed by a sustained course of maintenance laxative therapy. Lothian Guideline • Click on icons for quick link to our simple to use xxx YYY iiiii flow chart formulary referral checklist. • Referrals will not be accepted without evidence of use of the above guidance. • We have provided worked examples of common scenarios encountered in primary care (Figure 4). • Finally please see our links to other useful resources (Figure 5). Click b to return to top Lothian Guideline for Management of Idiopathic Childhood Constipation. Take a history - 2 or more from the following indicate that the child is constipated: • <3 stools per week............................................................................................................................ (type 3 or 4, see Bristol Stool Form Scale) Note - this does not apply to breast fed babies over 6wks who may stool less frequently. • Large stools that block the toilet or 'rabbit dropping' type 1 stool (see Bristol Stool Form Scale) • Overflow soiling (very loose, smelly stool passed without sensation) • Poor appetite that improves with passage of large stool.
    [Show full text]
  • Constipation in Adults Search Date October 2006 Frank Frizelle and Murray Barclay
    Dig . estive system disor Constipation in adults Search date October 2006 Frank Frizelle and Murray Barclay ABSTRACT INTRODUCTION: Although there are defined criteria for the diagnosis of constipation, in practice, diagnostic criteria are less rigid, and in part depend on the perception of normal bowel habit. Constipation is highly prevalent, with approximately 12 million general practitioner prescriptions for laxatives in England in 2001. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug interventions, and of other interventions, in adults with idiopathic chronic con- stipation? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 42 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: arachis oil, biofeedback, bisacodyl, cascara, docusate, exercise, glycerine suppositories, glycerol, high-fibre diet, increasing fluids, ispaghula husk, lactitol, lactulose, macrogols (polyethylene glycols), magnesium salts, methylcellulose, paraffin, phosphate enemas, seed oils, senna, sodium citrate enemas, sterculia. der QUESTIONS s What are the effects of non-drug interventions in adults with idiopathic chronic constipation?. 3 What are the effects of other treatments in adults with idiopathic chronic constipation?.
    [Show full text]
  • Docusate Sodium
    HEAD 03150148P00290148L03-M045UWASS FRONT 1ST BAR 1ST BAR >> READ DIRECTION >> READ DIRECTION 100 mg Capsules docusate sodium LAST BAR LAST BAR Package Leaflet: Information for the user Read all of this leaflet carefully before you • Constipation is an occasional problem for start taking this medicine because it some people - for others, it may happen contains important information for you. more often Always take this medicine exactly as described • Constipation happens when the normal in this leaflet or as your doctor or pharmacist muscle actions in the bowel slow down has told you. The cause of constipation is often not known. • Keep this leaflet. You may need to read it It can be linked with: again • Pregnancy • Ask your pharmacist if you need more • Lack of exercise information or advice • Sudden change of diet • If you get any side effects, talk to your • A diet with not enough fibre doctor or pharmacist. This includes any • Having to stay in bed for a long time possible side effects not listed in this leaflet. • Medicines such as morphine or codeine See section 4 • Loss of ‘tone’ of the bowel muscles in older • You must talk to a doctor or pharmacist if people you do not feel better or you feel worse • The full name of your medicine is DulcoEase Whatever the cause, constipation can be 100 mg Capsules. In this leaflet the shorter uncomfortable. It may make you feel bloated name DulcoEase is used and heavy or generally ‘off colour’. Sometimes it causes headaches. What is in this leaflet: Try these healthy tips to help prevent 1.
    [Show full text]
  • Prescribing Guidance for the Treatment of Constipation in Adults in Primary Care
    Surrey (East Surrey CCG, Guildford & Waverley CCG, North West Surrey CCG, Surrey Downs CCG & Surrey Heath) North East Hampshire & Farnham CCG, Crawley CCG and Horsham & Mid-Sussex CCG i Prescribing Guidance for the Treatment of Constipation in Adults in Primary Care. The British National formulary defines constipation as ‘the passage of hard stools less frequent than the patient’s own normal pattern’. While only 3% of young adults are constipated, 20% or more of the elderly population can be affected. It is more common in women due to their slower intestinal transit rate. Initial assessment should involve investigation of possible causes of constipation. Assessment should include the following: Assessment of bowel function Mobility Dexterity Dietary intake and the ability to chew/swallow Fluid intake Mouth care Underlying disease (figure 1) Medication (figure 2) Previous treatment for constipation. However, it is not always possible to identify an obvious underlying cause. Figure 1 Conditions which may cause or contribute to constipation • Bowel obstruction • Hypothyroidism • Irritable bowel syndrome • Neuromuscular disorders • Cancer (neurological) • Diverticular disease • Stimulant laxative abuse • Dehydration • Anorexia • Admission to hospital for any • Hypercalcaemia cause • Pregnancy Further investigation of all cases should be considered where: Constipation is a new symptom which is not due to changes in lifestyle, diet or drug therapy. Symptoms are severe and unresponsive to treatment. Alarm symptoms (‘red flags’) are present e.g. constipation alternating with diarrhoea, rectal bleeding, passing mucus per rectum, abdominal pain, weight loss, anorexia, tenesmus (painful and ineffectual straining). Colorectal cancer should be suspected in any adult who presents with alarm symptoms or altered bowel habit without an obvious cause.
    [Show full text]