IPU Medicines Counter Assistant (MCA) Course

Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Welcome to

Topic 4:
Gastrointestinal
Conditions –
Lower Digestive

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Aim

The main aim of Topic 4: Gastrointestinal

Conditions – Lower Digestive is to equip you
with the knowledge and skill to demonstrate
knowledge of OTC products available for the
treatment of minor illnesses and conditions,
advise on appropriate treatment options and
give practical recommendations to manage
illness and conditions.

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IPU Medicines Counter Assistant (MCA) Course
Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

This topic contains three parts:

Part 1. An Introduction to Conditions
Affecting the Lower Part of the
Topic Digestive System

Content Part 2. Ingredients Used in the

Treatment of Lower
Gastrointestinal Conditions
Part 3. When to Refer to a Pharmacist

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Learner Objectives

The learner objectives for this topic are:

• Describe the lower digestive tract and digestive process
• State and describe conditions affecting the lower part of the
digestive system
• List common causes of constipation, diarrhoea, irritable bowel
syndrome, threadworm and haemorrhoids
• List and describe OTC medicines for the treatment of constipation,
diarrhoea, irritable bowel syndrome, threadworm and haemorrhoids
and their suitable applications
• Demonstrate using the 2WHAM approach to make appropriate
recommendations for gastrointestinal conditions – lower digestive
• Identify and demonstrate when to refer standard and specific
patients to a Pharmacist

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Methodology

This topic is delivered using a blended format

of learning, including classroom teaching, case
studies, self-study, on-the-job coaching and
eLearning.

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Assessment
There are three assessments for this topic.
These include:
• On-line quizzes (summative test)
• Workplace assignment and skills demonstration
• Theory examination (formative test)

You are required to achieve a minimum grade of 80% for the

theory examination in order to achieve your certificate.
Successful students will receive an ATHE endorsed programme
certificate.

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

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1.1 The Anatomy of the Lower

Digestive Tract and the Digestive
Process
Part 1. 1.2 Definition and Description of the
Common Causes of Constipation
An Introduction 1.3 The Common Causes of
to Conditions Diarrhoea, its Usual Course and
Complications
Affecting the 1.4 The Presentation of Irritable
Bowel Syndrome, its Usual
Lower Part of Course and Common Triggers
the Digestive 1.5 Threadworm Infection, its
Symptoms, Life Cycle and Usual
System Sources
1.6 Definition of Haemorrhoids, their
Symptoms and Causes

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 1.1 The Anatomy of the Lower Digestive

Tract and the Digestive Process
Anatomy

This is the diagram of the

intestinal tract that we looked
at in Topic 3: Gastrointestinal
Conditions – Upper Digestive.
We will be concentrating on the
lower half.

See Student Handout

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Part 1.1 The Anatomy of the Lower Digestive

Tract and the Digestive Process
Lower Intestine
Transverse
• This diagram shows the lower Colon
half of the gut Ascending
• Digested food reaches this Colon Descending
section and the colon (large Colon
Ascending Colon
bowel) is where water is
absorbed from the faeces
• This is important because the
amount of water absorbed
determines the looseness of Sigmond
the bowel motion Colon
• The less water absorbed the
more watery and loose the
stool

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Part 1.2 Definition and Description of the

Common Causes of Constipation
Definition
• Less than 3 bowel movements per week
• Needing to strain to open the bowels on more than a
quarter of occasions
• Passing hard pellet like stools on more than a quarter of
occasions
Symptoms
• Stomach ache and cramps
• Feeling bloated
• Nausea
• Loss of appetite

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Part 1.2 Definition and Description of the

Common Causes of Constipation
Factors that Contribute Constipation
Pregnancy Inadequate nutrition (too little fibre
(displacement of intestines, hormone and fluid intake, irregular meal times, Ignoring the urge to pass stools
changes, etc.) improper eating habits)

Side effects of medication Immobility or lack of exercise

Symptoms of
constipation
Irritable bowel or systemic diseases
such as diabetes, Age-related sluggish bowel
hypothyroidism, etc

Changes in your routine or lifestyle,

such as a change in your eating Being underweight or over weight Anxiety or depression
habits

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Part 1.2 Definition and Description of the

Common Causes of Constipation
Who is most likely to suffer from constipation:
• Pregnant women
- During pregnancy the levels of hormones in the body
change, and this can result in constipation because it
makes the gut less active
- 40% of pregnant women experience constipation
- Mostly during the early stages of pregnancy
- May be accompanied by haemorrhoids

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Part 1.2 Definition and Description of the

Common Causes of Constipation
Who is most likely to suffer from constipation:
• Elderly people
- Elderly people tend to get constipated for several reasons:
• They don’t get much exercise
• Muscles in the gut get slower as we get older
• The elderly may not eat and drink enough to have daily bowel
movements
- Elderly people often think it is essential to pass a motion
every day – and sometimes use laxatives to keep them
regular, using laxatives continually can lead to
constipation
- Elderly people are more likely to be taking medicines
which may cause constipation

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Part 1.2 Definition and Description of the

Common Causes of Constipation
Constipation in Children
• 30% of children experience constipation
• Causes:
- Poor diet
- Toilet training
- Overfeeding
- Lack of fluids
• Psychological factors
- Fear of pain
- Environmental factors
- Ignoring the call to stool
• Refer to the pharmacist

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Part 1.2 Definition and Description of the

Common Causes of Constipation
Constipation and Drugs
• Lots of medicines can cause constipation as a side effect
• That is why you must always ask customers if they are
taking any medicines – and if they are, refer them to the
pharmacist
• Interestingly overuse of certain laxatives can lead to
apparent constipation (stimulant laxatives)
• If you think that the problem is due to a medicine your
customer is taking, check with your pharmacist – this
includes prescription and OTC medicines

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Part 1.2 Definition and Description of the

Common Causes of Constipation
Constipation and Drugs (contd.)
• OTC medicines that can cause constipation:
- Painkillers containing codeine
- Iron tablets
- Some travel sickness products
- Antihistamines
- Laxatives!!!!

• Prescription medicines
- Refer to the pharmacist

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Part 1.3 The Common Causes of Diarrhoea,

its Usual Course and Complications
• Most cases of diarrhoea are caused by infections
- 80% caused by viruses e.g. rota virus
- Viral gastroenteritis is highly contagious
- Careful handwashing is very important:
• after nappy changing
• before preparing food and feeding
- Sterilise bottles and teats
- Bacteria can also cause diarrhoea and are the cause of
food poisoning - Salmonella or E Coli
- The diarrhoea associated with food poisoning is generally
associated with nausea, vomiting and abdominal pain
• Sometimes caused by medicines
• Sometimes caused by excess alcohol and/or food
• Often on holiday
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Part 1.3 The Common Causes of Diarrhoea,

its Usual Course and Complications
Usual Course of Diarrhoea
• Usually mild and tends to settle within 48 hours
• Vomiting usually lasts for 24-48 hours
• Diarrhoea may persist for up to seven days
• Early reintroduction of dairy products can worsen or
prolong diarrhoea

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Part 1.3 The Common Causes of Diarrhoea,

its Usual Course and Complications
Diarrhoea and Dehydration
• Diarrhoea can cause significant dehydration in babies and
toddlers
• The most at risk are:
- Babies under 12 months
- Frequent stools >8 per day
- Vomiting >2 per day
- Not giving or tolerating any rehydration solution
- Have stopped breastfeeding

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Part 1.4 The Presentation of Irritable Bowel Syndrome,

its Usual Course and Common Triggers
• Irritable Bowel Syndrome (IBS) is a condition which affects
primarily women although men can be affected
• It affects up to 20% of people in Ireland
• It has no known cause, but seems to be linked to increased
susceptibility to stress, anxiety or depression
• IBS can be made worse by certain triggers such as
psychological factors including stress and anxiety or indeed
certain foods such as chocolate, caffeine, sweeteners,
dairy products, onions and garlic

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Part 1.4 The Presentation of Irritable Bowel Syndrome,

its Usual Course and Common Triggers
It is characterised by the following symptoms
• Abdominal Pain
- The pain can occur anywhere in the abdomen but is often in the middle or to
the left side
- The pain can sometimes occur after eating and may be relieved by passing a
bowel motion (defaecation)
• Bloating
- Sometimes so severe that clothes have to be loosened
• Constipation / Diarrhoea
- Alternating constipation and diarrhoea may occur
- Sometimes a morning rush occurs where the patient feels an urgent desire to
defaecate several times after getting up in the morning and following breakfast
after which the bowel may settle
- There may be a feeling of incomplete bowel emptying after a bowel movement
- The motion is often described as loose semi-formed rather than watery
- Sometimes it is like rabbit droppings or pellets, or pencil shaped
- There may be mucus present but never blood

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Part 1.5 Threadworm Infection, its Symptoms,

Life Cycle and Usual Sources
• As with head lice, people tend to associate threadworms
with poor hygiene and dirtiness, yet this assertion is just
not true
• Many parents feel unnecessarily embarrassed and
ashamed if their child gets worms, and one of the most
important things to do is reassure them that threadworms
are very common and are passed on very easily from one
person to another
• When children start school they may get threadworms –
or, indeed, head lice – because of close contact they are
bound to have with other children in the class
• It cannot be too strongly emphasised that there is nothing
to be embarrassed about with either of these conditions
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Part 1.5 Threadworm Infection, its Symptoms,

Life Cycle and Usual Sources
• There are several types of worms, but in this
country, threadworms are the most common
ones these days
• They are instantly recognisable because they
appear in a childs bowel motions and can be seen
as tiny, white moving creatures about 10mm in
length which resemble threads of cotton – hence
their name
• The worms can also be seen around the anus
(back passage)

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Part 1.5 Threadworm Infection, its Symptoms,

Life Cycle and Usual Sources
• The first sign that parents recognise is the child scratching their
bottom
• Sensitisation takes a while to develop, so in someone infected
for the first time, itching will not necessarily occur
• Itching is worse at night because at that time the female worms
emerge from the anus to lay their eggs on the surrounding skin
• Loss of sleep due to itching may lead to tiredness and
irritability during the day
• Itching without seeing the worms may be due to other causes,
such as an allergic or irritant dermatitis caused by soaps or
topical treatments used to treat itching
• In some patients, scabies or fungal infection may produce
itching
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Part 1.5 Threadworm Infection, its Symptoms,

Life Cycle and Usual Sources
Threadworm Lifecycle

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Part 1.5 Threadworm Infection, its Symptoms,

Life Cycle and Usual Sources
How do children catch threadworm?
• Threadworm eggs can survive for up to two weeks outside the body
• Transfer from skin around the anus and fall on to bedding, clothes, etc
• Wafted into the air when bedclothes are changed and become part of
the dust in a home
• Eggs can settle on food or toothbrushes
• Children then swallow some eggs at first by playing with other children
who have eggs on their fingers, or from food, drink, toothbrushes, or
dust that has been contaminated with threadworm eggs
• Threadworm only infect humans and cannot be caught from animals,
e.g. family pets

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Part 1.6 Definition of Haemorrhoids,

their Symptoms and Causes
• Haemorrhoids are very common
• Also known as piles
• They are estimated to affect up to 50% of the adult
population at some time in their lives
• It occurs equally in men and women and most commonly
between 20 and 50 years of age
• Customers with haemorrhoids will often be embarrassed
and must be treated with tact and discretion

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Part 1.6 Definition of Haemorrhoids,

their Symptoms and Causes
• Haemorrhoids are caused by the swelling of the veins
which line the anal canal
• Can be caused by straining during a bowel motion
• Can be caused or worsened by inadequate dietary fibre
of fluid intake
• Increased risk during pregnancy
• Haemorrhoids may be internal or external (protrude
through the anus

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Part 1.6 Definition of Haemorrhoids,

their Symptoms and Causes
• Symptoms of haemorrhoids include pain and discomfort,
as a result of swelling in the area of the rectum and anus,
which often becomes worse on defaecation
• Itching and burning also occur - the itching may be intense
• Internal piles may bleed and the blood seen on the surface
of the stool or splashed around the toilet bowl
• All cases of rectal bleeding should be referred to the
pharmacist

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2.1 The Role of Laxatives in the

Management of Constipation
2.2 The Treatment of Diarrhoea
Part 2. 2.3 The Medicines Used to Treat
Irritable Bowel Syndrome
A Review of the Including their Action, Correct
Use and Dosage
Ingredients Used 2.4 The Medicine Used to Treat
in the Treatment Threadworm, its Dose and
Timing and the Hygiene
of Lower Measure
Gastrointestinal 2.5 Topical Treatment for
Haemorrhoids, their Action and
Conditions Appropriate Use and the
Additional Advice which should
be given to Manage
Haemorrhoids

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Part 2.1 The Role of Laxatives in the

Management of Constipation
Bulking Agents
• Isphagula(Fybogel)
• Sterculia (Normacol)
• Psyllium Husk
• Work in three ways
- Increase size of the stools
- Increase the water content of the stool
- Soften the stool
• Act within 24 hours but take 2-3 days to have a full effect
• Take with plenty of water
• Can cause bloating and flatulence
• Do not take before going to bed as they may obstruct the
oesophagus

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Part 2.1 The Role of Laxatives in the

Management of Constipation
Osmotic Laxatives
• Lactulose
- Duphalac or Laxose
- Two mechanisms of action
- Draw water from the wall of the intestine into the gut
- Then broken down by bacteria in the gut to produce substances which
increase the speed at which the large intestine moves digested food
- Takes up to 3 days to have a full effect
• Macrogol
- Laxaclear, Dulcosoft
- Macrogol passes through the gut without being absorbed
- The water it is taken with is retained in the bowel instead of being
absorbed into the body
- This increases the water content and volume of the stools making them
softer
- Takes up to 2 days to have a full effect
- Children over 12 only

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Part 2.1 The Role of Laxatives in the

Management of Constipation
Stimulant Laxatives
• Two mechanisms of action:
- Stimulate wall of the intestine to secrete water into
the gut
- Stimulate nerves controlling the gut to prevent
water absorption from the gut
• Short term use only
• Useful where rapid relief is required
• Refer to the pharmacist is no relief after 7 days of use

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Part 2.1 The Role of Laxatives in the

Management of Constipation
Senna Tablet and Bisacodyl (Dulcolax Tablets)
Liquid (Senokot) Sodium Picosulphate (Dulcolax Liquid)
• Dose • Dose
̶ 2 tablets at night for a ̶ 1 tablet swallowed whole at night
maximum of 7 days increase to 2 if no response
̶ Children over 12 only ̶ 5ml liquid at night increase to 10mls if no
̶ Liquid can be used in response
children under 12 with
pharmacist supervision ̶ 1 suppository for immediate effect
only ̶ Short term use only
• Speed of action ̶ Children under 10 refer to the pharmacist
̶ 6-12 hours • Speed of action
• Side effects ̶ Tablets 6-10 hours
̶ Cramping ̶ Suppositories 15-30 minutes
̶ Liquid 10-14 hours
• Side effects
̶ Cramping
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Part 2.1 The Role of Laxatives in the

Management of Constipation
Micralax
Ingredients
• Sodium citrate • Acts within 15-30 minutes
- Releases bound water in stool
in a physical-chemical process
• Useful for children and
babies.
• Sorbitol solution
- Increases the effect of sodium • Administered rectally
salts - Lubricate the tip of the tube
• Sodium lauryl sulfoacetate using a few drops of the
solution
- A non-toxic, non-irritating
wetting agent that facilitates - Only insert the tube halfway
in children under 3 (refer to
the penetration of the
solution into the faeces pharmacist)

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Part 2.1 The Role of Laxatives in the

Management of Constipation
Laxatives which are not recommended
• All pharmacies have products for sale which have laxative properties but
should not be recommended for this use
• The two most common are:
̶ Epsom Salts
• Excessive dose or frequent use can cause
- Muscle weakness
- Irregular heartbeat
• It can interact with other medication
• Can safely be sold as a muscle soak without referral to the pharmacist
̶ Liquid Paraffin
• It reduces the absorption of fat soluble vitamins
• Irritates the anus and can cause seepage from the anus
• Never use if abdominal pain or vomiting

Refer requests for these products to the pharmacist

if being used for laxative purposes

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Part 2.1 The Role of Laxatives in the

Management of Constipation
Choosing a Laxative
• Regular use
- Bulking agent
- Lactulose
- Macrogol

• Short term use to restore normal bowel habit

- Stimulant laxative
- Micralax

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Part 2.2 The Treatment of Diarrhoea

Adults and Children over 12

• Loperamide is the modern anti-diarrhoeal, it slows down
the gut
• Rehydration sachets or tablets such as Dioralyte, ORS or
Electrosal are very important to replace lost fluids,
especially in babies, children and elderly people
• Tasectan or Dioclear

Children under 12
• Rehydration sachets
• Tasectan or Dioclear

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Part 2.2 The Treatment of Diarrhoea

Diarrhoea in Children
• Dehydration is a danger and must be avoided
• For children, rehydration sachets are the best treatment;
they can be given to babies and children and help to
replace the fluid that has been lost
• It is most important that you advise customers on three
issues relating to the use of oral rehydration fluids:
- How to make them up
- How to store them
- How much to give - which depends on:
• The age of the person
• How much diarrhoea they have had

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Part 2.2 The Treatment of Diarrhoea

Rehydration Sachets
• Dioralyte - Make up each sachet with 200ml (7 fl.oz.) of
freshly boiled and cooled water
• ORS Tablets – Dissolve one tablet in 100ml of freshly
cooled boiled water
• Store in the fridge and discard after 24 hours
• Make sure the customer knows how much fluid to give
- Under 1 year 50ml per watery stool
- 1-5 years 100ml per watery stool
- 6-12 years 200ml per watery stool
- Adults 400ml per watery stool

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Part 2.2 The Treatment of Diarrhoea

Rehydration Solution
• Rehydrate rapidly over 3-4 hours
• If the child is vomiting, give small amounts of solution
(5mls) every five minutes
• Use a cup or a spoon rather than a bottle
• The solution can be frozen and given as an ice lolly
• Use flavoured solutions in children over 12 months if
preferred

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Part 2.2 The Treatment of Diarrhoea

Diarrhoea in Children
• Continue breast feeding
• Restart bottle feeding once rehydration is complete
• Do not dilute formula
• Do not give soft drinks such as flat 7UP or Lucozade as they
may worsen diarrhoea
• Reintroduce solid food as soon as possible even if the
diarrhoea persists (avoid fatty or sugary foods initially)
• Children should be back on full diet within 24 hours of
starting treatment

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Part 2.2 The Treatment of Diarrhoea

Loperamide 2mg (Arret and Imodium Products)

• Adults and children over • Slows down the intestine
12 only and reduces water content
• Dose: of the stools
̶ Two tablets or capsules to • Combined with
start simethicone for bloating
̶ Take another one with each and cramping in Imodium
subsequent loose bowel Plus
motion to a maximum total
dose of 5 tablets or capsules • Do not use if:
in 24 hours ̶ Bacterial infection suspected
• Advise about benefit ̶ Recent course of antibiotics
rehydration in addition to • Side effects:
loperamide ̶ May cause drowsiness

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Part 2.2 The Treatment of Diarrhoea

Gelatin Tannate
• Found in Tasectan
• Diarrhoea is an imbalance between absorption and
secretion of water caused by toxins
• Gelatin Tannate forms a film over the intestinal wall which
protects the intestinal wall and promotes excretion of
toxins
• Usually works within 12 hours
• Capsules are not suitable for children (under18)

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Part 2.2 The Treatment of Diarrhoea

Gelatin Tannate (contd.)

• Adults
- 1-2 capsules every 4-6 hours
• Children aged 14-18
- 2 sachets every 6 hours
• Children aged 3-14
- 1-2 sachets every 6 hours
• Children under 3
- 1 sachet every 6 hours
• Add to fruit juice or yoghurt
• These products should be used in conjunction with oral
rehydration

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Part 2.2 The Treatment of Diarrhoea

Diosmectite
• Found in Dioclear
• A magnesium, aluminium clay
• Adsorbs water and diarrhoea causing toxins
• Reduces stool frequency in mild to moderate diarrhoea
• NOT to be used as a substitute for oral rehydration in children
• Adults
- One sachet in 100mls of water three times daily
• Children 6-12 years
- 2-3 sachets per day
• Children 1-6 years
- 1-2 sachets per day

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Part 2.2 The Treatment of Diarrhoea

Holiday Diarrhoea
• Families
- Possible recommendations
- Loperamide (adults and children over 12)
- Rehydration sachets for younger children (use bottled water)
• For a family going on holiday, a good recommendation would
be some Arret capsules for the adults and some rehydration
sachets for the children and adults - this should provide
treatment for everyone
• Remind customers that, to be on the safe side, they can make
up the rehydration sachets with bottled water (still, rather
than bubbly, as carbonated water will upset the electrolyte
balance)
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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 2.2 The Treatment of Diarrhoea

Advice for Travellers

The following tips will help reduce the incidence of travellers
diarrhoea:
• Drink bottled water or water sterilised with purification
tablets
• Avoid ice and ice cream
• Avoid salads and uncooked vegetables
• Avoid fruit that cannot be peeled
• Avoid unpasteurised milk
• Avoid murky swimming pools

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Part 2.3 The Medicines Used to Treat IBS Including

their Action, Correct Use and Dosage
Peppermint Oil (Colpermin, Senocalm)
• Relaxes muscle easing pain and cramping
• Take 15-30 mins before food, swallow whole
• Can cause heartburn

Mebeverine (Fybogel Mebeverine)

• Relieves pain and cramping
• Take 20 mins before food

Bulking agents (Fybogel etc)

• Bran is not recommended as may make symptoms worse
• Dose is a matter of trial and error
• Increase fluid intake also

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 2.3 The Medicines Used to Treat IBS Including

their Action, Correct Use and Dosage
Hyoscine Butylbromide
• Buscopan
• Relieves the cramping and spasm by relaxing the walls of
the intestine
• Adults and children over 12
• Not to be used if patient suffers from glaucoma
• For abdominal cramps
- Two tablets four times a day
• For IBS
- Start with one tablet three times a day
- Increase gradually up to two tablets four times a day if
necessary

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Part 2.3 The Medicines Used to Treat IBS Including

their Action, Correct Use and Dosage
Advice for IBS sufferers
• Eat regular meals
• Don’t rush meals
• Keep well hydrated
• Limit tea and coffee intake (3 cups per day)
• Reduce alcohol and fizzy drink intake
• For some people it can be helpful to reduce intake of high
fibre foods such as
̶ Wholemeal bread or cereals
̶ Wholegrains such as brown rice, wholewheat pasta
• Limit fresh fruit to three portions per day
• Avoid artificial sweeteners

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 2.4 The Medicine Used to Treat Threadworm, its

Dose and Timing and the Hygiene Measure
• Treatment of threadworms is really very simple, but in
order to be successful it must be combined with a hygiene
routine to ensure that reinfection doesn’t happen
• How people get threadworms was discussed earlier
• What is needed is to break this cycle by making sure that
new eggs do not reach the mouth of the infected person
• Persistent or particularly heavy cases of threadworm in
children can cause loss of appetite and weight loss,
insomnia and irritability - such cases should be referred to
the pharmacist

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Part 2.4 The Medicine Used to Treat Threadworm, its

Dose and Timing and the Hygiene Measure
Treatment
• There is only one product available OTC to treat
threadworm: Mebendazole
• Mebendazole is available as Vermox tablets and suspension
• It kills the worms in a single dose
• Treat every member of the family
• A second dose is rarely needed, and is only recommended if
the hygiene routine is not followed
• The important point about Mebendazole is that, provided
you can stop eggs being reintroduced into the mouth, a
single dose will be effective

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IPU Medicines Counter Assistant (MCA) Course
Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 2.4 The Medicine Used to Treat Threadworm, its

Dose and Timing and the Hygiene Measure
Treatment (contd.)
• It is rather unusual to have a product where the customer buys
only a single tablet, so it is very important to explain to the
customer how the product works and why only one tablet is
needed. Remember though that we are recommending that the
whole family be treated so more than one tablet will be needed
• Mebendazole is a very safe drug and has no known side effects
• Mebendazole can be used to treat other kinds of worm
infection, such as pinworms and hookworms but this required a
higher dose and where you suspect that the infection is caused
by one of these worms of if a customer requests mebendazole
to treat such an infection you should refer the customer to the
pharmacist

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Part 2.4 The Medicine Used to Treat Threadworm, its

Dose and Timing and the Hygiene Measure
Treatment (contd.)
• It is important to remember that mebendazole should not be
taken by pregnant or breastfeeding women
• If a pregnant woman asks for a treatment for threadworms,
always refer her to your pharmacist
• You are not, of course always going to be able to tell if a
woman is pregnant, or your customer is buying it for another
person who is pregnant
• The best way around this is to explain to the customer that
the product should not be used by pregnant women
• You could do this when you give them the other information
about the product

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 2.4 The Medicine Used to Treat Threadworm, its

Dose and Timing and the Hygiene Measure
Hygiene Measures
• What you are trying to do is stop eggs from the skin around
the anus being transferred to the mouth and thereby
restarting the cycle
• It is absolutely crucial that you explain this to the customer
when selling a threadworm treatment
• Fingernails - Keeping the fingernails short, and brushing and cleaning
them regularly. The routine of cleaning the nails with a nailbrush after
going to the toilet and before meals will help to reduce the likelihood of
the eggs being reintroduced into the system
• Cotton Gloves - The wearing by children of cotton gloves in bed as
well as pyjama bottoms will help to stop the fingernails coming into direct
contact with the infected skin

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Part 2.4 The Medicine Used to Treat Threadworm, its

Dose and Timing and the Hygiene Measure
Hygiene Measures (contd.)
• Bedroom – Vacuum the bedroom regularly
• Bed linen and towels - These should be washed frequently at a
high temperature and underwear and nightclothes changed daily
• Bath or shower - taken early in the morning helps to remove eggs
laid overnight
• Some patients may not obtain instant relief of symptoms
after use of an antithelminthic, in such cases Eurax cream
may be helpful
• The patient information leaflets for Vermox outlines the
hygiene measures

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 2.5 Topical Treatment for Haemorrhoids, their Action

and Appropriate Use and the Additional Advice
which should be given to Manage Haemorrhoids
• Most cases of haemorrhoids are managed by treatment with creams,
ointments and suppositories, plus the use of laxatives where
necessary to reduce straining
• Treatment should be applied morning and evening and after each
bowel motion
• The commonly used OTC treatments contain some of the following
ingredients
• Astringents:
- These agents work by forming a protective layer on the surface of the
anal canal which helps to relieve local irritation and inflammation
- They also help to strengthen the wall of the vein
- Anusol preparations contain a combination of several different
astringents
- Bismuth
- Peru balsam
- Zinc oxide

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Part 2.5 Topical Treatment for Haemorrhoids, their Action

and Appropriate Use and the Additional Advice
which should be given to Manage Haemorrhoids
• Hydrocortisone
- Found in Anusol HC
- Hydrocortisone relieves the pain and inflammation
associated with severe haemorrhoids
- It should only be used in adults and then for no longer
than seven days
- Use no more than four times a day
- It should not be used during pregnancy or in
breastfeeding women

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 2.5 Topical Treatment for Haemorrhoids, their Action

and Appropriate Use and the Additional Advice
which should be given to Manage Haemorrhoids
• Shark Liver Oil
- Shark liver oil is a source of vitamin A and has been
used as a skin protectant
- Found in Preparation H

• Yeast Cell Extract

- Yeast cell extract is claimed to promote wound healing
and tissue repair

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Part 2.5 Topical Treatment for Haemorrhoids, their Action

and Appropriate Use and the Additional Advice
which should be given to Manage Haemorrhoids
Additional Advice
• Take a bulking agent regularly
• Drink plenty of fluids
• Avoid straining when passing a stool
• Ensure good hygiene
• Warm baths can relieve the symptoms

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IPU Medicines Counter Assistant (MCA) Course
Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 3. 3.1 Constipation

When to Refer 3.2 Diarrhoea
to the 3.3 Irritable Bowel Syndrome
Pharmacist 3.4 Haemorrhoids

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Part 3.1: When to Refer - Constipation

• Constipation in children
• Anyone who has been constipated for longer than 14 days
• Anyone with continuous abdominal pain, or pain that is
continuous/severe/worsening
• Pregnancy
• Vomiting
• Blood in Stools

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 3.1: When to Refer - Constipation

• If the customer has tried a medicine already to treat the

symptoms, and it hasn’t worked
• Any customer who is taking other medicines
• Talk to the pharmacist and agree together who should be
referred

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Part 3.2: When to Refer - Diarrhoea

• Diarrhoea in babies and children under 3

• Diarrhoea longer than 2 days (adults) or 24 hours (children)
• Vomiting or fever
• Recent foreign travel
• Blood in the stools
• Pregnancy
• OTC medicine tried with no result
• Taking other medicines

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Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 3.3: When to Refer - Irritable Bowel

Syndrome
• Children
• Pregnant or breastfeeding women
• Treatment already tried
• On other medication
• First time the patient has symptoms of IBS
• 40 years or over and it is some time since the last episode of IBS /
abdominal cramps, or the symptoms are different this time
• Recently passed blood from the bowel
• Loss of appetite or lost weight
• Severe constipation
• Fever
• Recent foreign travel

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Part 3.4: When to Refer - Haemorrhoids

• Lasting longer than 3 weeks

• Blood in the stool
• On other medication
• Pregnant or breastfeeding women
• Abdominal pain or vomiting

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IPU Medicines Counter Assistant (MCA) Course
Topic 4 – Gastrointestinal Conditions and Treatments – Lower Digestive

Part 1. An Introduction to Conditions

Affecting the Lower Part of the
Digestive System
Topic Part 2. Ingredients Used in the
Treatment of Lower
Recall Gastrointestinal Conditions
Part 3. When to Refer to a Pharmacist

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