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, some-times 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 occur-ring 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 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 develop 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 on R.H. case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present on the case study.
- Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided on the case study?
- Constipation is a condition characterized by infrequent bowel movements or difficulty in passing stools. It can be caused by various factors, including:
a) Inadequate fiber intake: Not consuming enough dietary fiber can lead to harder and drier stools, making them difficult to pass.
b) Lack of physical activity: Regular exercise promotes healthy bowel movements by stimulating the muscles in the intestines.
c) Insufficient fluid intake: Dehydration can result in harder stools and increased difficulty in passing them.
d) Medications: Certain medications, such as opioids, antacids containing aluminum or calcium, and some antidepressants, can cause constipation as a side effect.
e) Hormonal changes: Fluctuations in hormones, such as during pregnancy or menopause, can contribute to constipation.
f) Age: Older adults, like R.H., are more prone to constipation due to slower bowel motility and reduced muscle tone in the intestines.
Recommendations for managing constipation may include:
- Increasing dietary fiber: Consuming more fruits, vegetables, whole grains, and legumes can add bulk to the stool and facilitate easier bowel movements.
- Staying hydrated: Drinking an adequate amount of water throughout the day helps maintain proper bowel function.
- Regular exercise: Engaging in physical activity, such as walking or moderate aerobic exercise, can help stimulate bowel movements.
- Establishing a routine: Establishing regular times for bowel movements can train the body to have more predictable bowel habits.
- Avoiding delaying bowel movements: Ignoring the urge to have a bowel movement can lead to constipation. Responding to the body’s signals in a timely manner is important.
- Over-the-counter options: If lifestyle changes are insufficient, over-the-counter laxatives or stool softeners may provide temporary relief. However, it’s important to consult a healthcare professional before using them.
Based on my experience, I have found that incorporating fiber-rich foods and staying hydrated while maintaining regular exercise has been effective in managing constipation for many individuals.
- Clinical manifestations in R.H.’s case study compatible with constipation include:
- Feeling bloated and experiencing infrequent bowel movements (once a week).
- Straining during bowel movements and taking a significant amount of time (10 minutes) to initiate a bowel movement.
- Passing hard stools.
- Previous negative colonoscopy ruling out tumors or other lesions.
Additional signs and symptoms of constipation that are not mentioned in the case study but may be observed in some individuals include:
- Abdominal pain or discomfort.
- A sense of incomplete evacuation after a bowel movement.
- Rectal bleeding or hemorrhoids due to straining.
- Loss of appetite or decreased food intake.
- Nausea or vomiting (in severe cases).
- The information provided in the case study does not suggest the presence of anemia. Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin in the blood, which can lead to fatigue, weakness, and paleness. Although anemia can be associated with certain chronic conditions and gastrointestinal bleeding, it is not directly linked to constipation in this case study. However, it’s important to conduct a comprehensive medical evaluation to rule out any underlying causes that may contribute to both constipation and anemia.