Definition of constipation and risk factors that lead to constipation

Gastrointestinal Function: R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, sometimes going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occurring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain in her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise. Case Study Questions In your own words define constipation and name the risk factors that might lead to developing constipation. List recommendations you would give to a patient who is suffering from constipation. You might use a previous experience you might have. Based on the clinical manifestations in R.H.'s case study, name and explain the signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present in the case study. Sometimes as an associated diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided in the case study?

Sample Solution

Case Study: R.H.'s Constipation and Heartburn

Constipation Defined:

Constipation refers to infrequent or difficult bowel movements. It typically involves stools that are hard, dry, and difficult to pass. While occasional constipation is common, experiencing symptoms like R.H.'s for a month suggests a potential underlying issue.

Risk Factors for Constipation:

Diet: Low fiber intake, dehydration, and certain medications can contribute.
Lifestyle: Inactivity, sedentary lifestyle, and travel can disrupt bowel habits.
Medical conditions: Thyroid disorders, diabetes, and neurological issues can influence digestion.
Medications: Pain relievers like naproxen, antidepressants, and iron supplements can cause constipation.
Pelvic floor dysfunction: Weakened or tight pelvic muscles can affect stool passage.

Recommendations for Constipation:

Dietary changes: Increase fiber intake through fruits, vegetables, and whole grains. Stay hydrated with water throughout the day.
Exercise: Regular physical activity promotes gut motility and bowel regularity.
Behavioral changes: Establish a regular toileting routine and respond promptly to the urge to move bowels.
Over-the-counter medications: Stool softeners or laxatives can provide short-term relief, but use cautiously and under guidance.
Biofeedback: Training pelvic floor muscles can improve bowel control in some cases.

Full Answer Section

R.H.'s Signs and Symptoms of Constipation:

Bloating: Discomfort due to trapped gas and stool.
Infrequent bowel movements: One per week versus her usual daily routine.
Straining: Difficulty passing stools.
Hard stools: Difficulty evacuating due to stool consistency.

Additional Symptoms Not Present:

Abdominal pain
Blood in stool
Weight loss

Anemia as a Complication:

While constipation itself doesn't directly cause anemia, long-term or severe cases can sometimes lead to iron deficiency anemia. This can occur if constipation interferes with iron absorption in the intestines. However, without additional information like blood tests, considering anemia in R.H.'s case based solely on the provided information is difficult.

Further Considerations:

R.H.'s age and ethnicity are factors to consider, as constipation prevalence increases with age and can be higher in certain ethnicities.
The use of naproxen could be contributing to her constipation.
Her inactivity due to worsening arthritis might also be a factor.

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare professional for diagnosis and treatment of any medical condition.

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