{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 16, Ep 1 of 3: Chronic Constipation Pharmacology and OIC","html":"","width":"100%","height":180,"duration":961,"description":"Episode one of the Pelvic Floor and Anorectal Disorders chapter works through chronic constipation as a symptom-defined syndrome, the empiric laxative sequence that resolves most patients, and the prescription drugs for refractory disease mapped to four molecular targets. The organizing idea: match the drug to the mechanism, and keep opioid-induced constipation separate because the enteric receptor never develops tolerance. Definitions, alarm features, secondary causes, secretagogues, prucalopride, and the peripherally acting opioid antagonists throughout, all framed around the exam stem that names the mechanism.\n \nTopics covered\n\nSymptom-defined diagnosis of chronic constipation\nThree mechanistic subtypes: normal-transit, slow-transit, defecatory\nAlarm features and secondary causes\nEmpiric sequence: diet, fiber, osmotic, stimulant laxatives\nPrescription secretagogues and their four targets\nPrucalopride as the serotonin-4 prokinetic\nOpioid-induced constipation and tolerance asymmetry\nPeripherally acting opioid antagonists and the obstruction contraindication\n \n \nKey decisions\n\nChronic constipation is diagnosed on symptoms over at least three months, not stool frequency alone; infrequent movements without straining, hard stools, or incomplete evacuation is bowel-frequency variation and gets reassurance, not a secretagogue.\nAlarm features (new symptoms over age fifty, weight loss, bleeding or iron-deficiency anemia, family history of colorectal cancer or IBD) send the patient to colonoscopy now instead of empiric polyethylene glycol.\nThe empiric sequence is education and diet, soluble fiber titrated toward twenty-five to thirty grams a day with psyllium preferred, polyethylene glycol seventeen grams daily first-line, then bisacodyl or senna, run over four to eight weeks.\nLubiprostone is dosed at twenty-four micrograms twice daily for chronic constipation versus eight micrograms twice daily for IBS-C; linaclotide is one hundred forty-five micrograms daily versus two...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}