Definition of constipation and risk factors that might 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

Constipation in R.H.: Assessment and Recommendations

Constipation Definition:

Constipation refers to difficulty passing stool, characterized by infrequent bowel movements, hard stools, and straining during defecation. Normal bowel habits can vary between individuals, but generally, having fewer than three bowel movements per week with hard, difficult-to-pass stools can be considered constipation.

Risk Factors for Constipation:

Diet: Low fiber intake, dehydration, and excessive intake of processed foods or dairy can contribute to constipation.
Activity level: Lack of physical activity can slow down stool movement through the digestive system.
Medications: Certain medications like pain relievers (opioids, NSAIDs), antidepressants, and anticholinergics can cause constipation as a side effect.
Medical conditions: Thyroid disorders, diabetes, neurological conditions, and structural abnormalities in the colon can also contribute.
Age: Constipation becomes more common with increasing age due to reduced muscle tone and slower digestive processes.

Recommendations for Constipation Relief:

Lifestyle:

Increase fiber intake: Aim for 25-35 grams of fiber daily through fruits, vegetables, whole grains, and legumes.
Hydrate adequately: Drink plenty of water throughout the day to soften stools.
Regular exercise: Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
Establish a regular bathroom routine: Try to go to the bathroom at the same time each day, even if you don't feel the urge initially.
Manage stress: Stress can exacerbate constipation. Relaxation techniques like yoga or meditation can be helpful.

Full Answer Section

Dietary:

Limit processed foods, sugary drinks, and dairy products: These can worsen constipation.
Include prunes, figs, and other dried fruits: These are naturally high in fiber and have mild laxative effects.

Over-the-counter options:

Bulk-forming laxatives: Psyllium husk (Metamucil) can increase stool bulk and promote regularity.
Stool softeners: Docusate sodium (Colace) can soften stools making them easier to pass.

Consult a doctor if:

Constipation is severe or persistent
Blood is present in stools
Abdominal pain is severe
You experience sudden changes in bowel habits

R.H.'s Case and Constipation Symptoms:

Present:

Infrequent bowel movements (weekly)
Hard stools
Straining during defecation
No recent colonoscopy findings (reduces likelihood of structural issues)

Absent:

Abdominal pain
Blood in stool
Recent medication changes

Additional Signs and Symptoms of Constipation:

Bloating
Feeling of incomplete evacuation
Gas
Hemorrhoids

Anemia Possibility:

Based solely on the provided information, it's difficult to determine if R.H. is at risk for anemia due to constipation. While chronic constipation can sometimes lead to iron deficiency anemia due to blood loss from straining, there's no mention of blood in her stool. Further investigation, including blood tests, would be needed to assess her iron levels and rule out anemia.

It's important to note that this is for educational purposes only and does not constitute medical advice. Please consult a healthcare professional for personalized diagnosis and treatment recommendations.

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