From the Guidelines
The treatment plan for a patient with vertigo and constipation should prioritize vestibular rehabilitation therapy and lifestyle modifications, including increased fluid intake, dietary fiber, and regular physical activity, as these approaches have been shown to be effective in managing both conditions. For vertigo, vestibular suppressants such as meclizine 25mg every 6-8 hours as needed for acute symptoms, or diazepam 2-5mg every 8 hours for severe cases, can be used to reduce the sensation of spinning by suppressing vestibular input to the brain 1. However, according to the most recent and highest quality study, vestibular rehabilitation therapy is recommended as a first-line treatment for persistent vertigo, as it can help the brain compensate for balance disturbances 1.
For constipation, lifestyle modifications including increased fluid intake (2-3 liters daily), dietary fiber (25-30g daily), and regular physical activity should be initiated first. If these measures are insufficient, an osmotic laxative like polyethylene glycol (MiraLAX) 17g daily or magnesium citrate 200-300mg daily can be added 1. For more resistant constipation, stimulant laxatives such as bisacodyl 5-10mg or senna 8.6-17.2mg can be used short-term.
Some key points to consider in the treatment plan include:
- Investigating potential underlying causes for both conditions, as vertigo may result from inner ear disorders, central nervous system issues, or medication side effects, while constipation could stem from dietary factors, medication effects, or gastrointestinal disorders.
- Carefully considering medication choices, as some medications used for vertigo, particularly anticholinergics like scopolamine, can actually worsen constipation.
- Ensuring patient education and empowerment, as patient understanding and adherence to the treatment plan are crucial for effective management of both conditions 1.
- Monitoring for potential complications, such as falls or bowel obstruction, and adjusting the treatment plan as needed.
Overall, a comprehensive treatment plan that addresses both vertigo and constipation, and prioritizes lifestyle modifications and vestibular rehabilitation therapy, can help improve patient outcomes and quality of life.
From the Research
Vertigo Management
- The patient has been given Cetirizine to address reported vertigo symptoms 2
- The choice of medications for vertigo is determined by the known side effects of the drugs and the time course of symptoms 3
- Classes of medications useful in the treatment of vertigo include anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists 2
- The patient's mother has been instructed to monitor for recurrence or worsening of vertigo and to return to the clinic if needed
Constipation Management
- A KUB (Kidneys, Ureters, Bladder) X-ray has been ordered to assess for bowel obstruction or significant stool burden, especially in light of the patient's chronic constipation history
- The patient's mother has been provided with extensive education on increasing fiber in the child's diet, including:
- Increasing intake of fruits, vegetables, and whole grains
- Offering prune juice
- Increasing overall water intake/hydration
- The patient's mother has been instructed to monitor bowel movement frequency and consistency
- Management of constipation is frequently poor, and a combination of softening and stimulant laxatives is most likely to be successful with minimum adverse effects 4
Patient/Caregiver Education & Understanding
- The patient's mother has verbalized understanding of the treatment plan for both vertigo and constipation, including dietary modifications and when to seek further medical attention
Follow-up
- The patient's mother has been instructed to return to the clinic if vertigo persists or worsens, or if constipation does not improve with dietary changes and prune juice, or if new symptoms develop 5, 6
- The results of the KUB X-ray will be reviewed and further management planned based on the findings