Constipation 

functional contipation  - straining more than 25% of the time 

rectal outlet delay 

frail patients- delay or increased total gut transit time - weaker abdominal muscles, weaker spincter 

symptoms 

straining 

decreased bowel motion : < 3 per week 

> 10 mins 

sense of incomplete defecation 

preventive 

increase oral intake 

start - increase level of strength 

sorbitol 15 ml - 30ml 

senna - stimulant that makes it easier to pass 

bisocadyl - stimulant laxatives - for rectal dyschezia - difficult with defecation

stool softener like decosuate sodium - use when straining is to be avoided ( MI, hemorrhoids, post surgery )