Gastrointestinal Function: A 74-Year-Old Black Woman 803817

Gastrointestinal Functionrh Is A 74 Year Old Black Woman Who Prese

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, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her at least 10 minutes to initiate a bowel movement. Her stools have been extremely hard. She denies pain during straining and has had a recent colonoscopy that was negative for tumors or other lesions. She has not yet taken any medications for her constipation. Additionally, she reports frequent heartburn (3–4 times weekly), most often occurring soon after lying down. She uses three pillows to keep herself upright during sleep. She purchased OTC aluminum hydroxide tablets on a friend's advice, with some improvement. She regularly takes naproxen for arthritis in her hands and knees, which has become worse, leading her to stop her daily walks and engage in minimal exercise.

Case Study Questions:

- Define constipation and list risk factors.

- Provide recommendations for a patient suffering from constipation.

- Based on R.H.’s clinical manifestations, identify signs and symptoms compatible with constipation.

- List additional signs and symptoms not present in the case that could be associated.

- Consider if anemia could be a complication of constipation based on her presentation.

Paper For Above instruction

Introduction

Constipation is a common gastrointestinal disorder characterized by infrequent bowel movements, difficulty during defecation, or the passage of hard, dry stools. Typically, it is defined as fewer than three bowel movements per week, accompanied by straining, hard stool, or a sensation of incomplete evacuation (Ng et al., 2019). It affects individuals across all age groups but is particularly prevalent among older adults due to physiological changes, comorbidities, and medication use.

Risk Factors for Constipation

Several risk factors predispose individuals to constipation. Age is a significant factor, as aging affects colonic motility and stool consistency. Dietary habits, especially low fiber intake, contribute to stool hardening and reduced motility (Colby et al., 2020). Sedentary lifestyle or decreased physical activity, as noted in R.H.'s case due to arthritis and reduced walking, impairs bowel movements. Medications such as opioids, anticholinergics, and nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen can slow intestinal transit. Additionally, psychological factors such as stress or depression, dehydration, ignoring the urge to defecate, and neurological conditions can increase risk.

Recommendations for Managing Constipation

Management begins with lifestyle modifications. Increasing dietary fiber intake, through fruits, vegetables, and whole grains, helps bulk stool. Adequate hydration—approximately 8-10 glasses of water daily—softens stool and promotes regularity (Kelley et al., 2021). Regular physical activity, tailored to her arthritis condition, can stimulate bowel movements. Encouraging routine bowel habits and allowing sufficient time for defecation without rushing is essential. For immediate relief, osmotic laxatives such as polyethylene glycol can be used, along with stool softeners if necessary. Pharmacologic treatment should be tailored to individual needs, and use of stimulant laxatives should be limited to short-term relief to prevent dependence. If dietary and lifestyle measures fail over a period of weeks, referral to a gastroenterologist for further evaluation may be necessary to rule out secondary causes like obstructive lesions or metabolic disorders.

Clinical Manifestations in R.H.

The case study highlights classic signs of constipation: infrequent bowel movements (once a week), prolonged straining, and hard stools. She experiences increased difficulty initiating defecation, consistent with slow colonic transit or outlet dysfunction. Although she denies pain, her straining, duration, and stool consistency align with constipation. Her use of multiple pillows for heartburn suggests reflux, possibly exacerbated by her supine position, which can also influence bowel habits by increasing intra-abdominal pressure.

Additional less obvious signs indicating possible complications include hemorrhoids due to straining and hard stools, which can cause bleeding, and possibly anal fissures. Her self-treatment with OTC antacids suggests ongoing gastroesophageal reflux disease (GERD), which may be aggravated by increased intra-abdominal pressure during straining. Notably, she does not report rectal bleeding, weight loss, or anemia symptoms, which are critical to assess for secondary causes or complications like anemia.

Potential for Anemia in Constipation

While anemia is not a direct consequence of constipation, chronic hemorrhoids resulting from straining and hard stools can lead to occult bleeding, causing iron deficiency anemia over time (Kellner et al., 2017). Given her prolonged constipation and straining, she is at increased risk for hemorrhoidal bleeding, which warrants evaluation if she develops symptoms like fatigue, pallor, or dizziness. Routine screening for anemia should be considered if her symptoms evolve, especially if there are signs of significant bleeding.

Conclusion

Constipation is a multifactorial disorder often linked to lifestyle, medications, and comorbidities, especially in older adults. R.H.'s presentation underscores common clinical features, which can be alleviated through dietary, lifestyle, and pharmacological interventions. Monitoring for complications such as hemorrhoids and anemia is essential, and personalized management strategies should be employed to improve her quality of life and prevent adverse outcomes.

References

1. Colby, S. M., et al. (2020). Management of constipation in older adults. Gastroenterology & Hepatology, 16(10), 579-591.
2. Kelley, D., et al. (2021). Dietary fiber and gastrointestinal health. Nutrition Reviews, 79(4), 433-445.
3. Kellner, D., et al. (2017). Hemorrhoids, bleeding, and anemia: Pathophysiology and management. World Journal of Gastroenterology, 23(2), 246-259.
4. Ng, Q. X., et al. (2019). Functional constipation: Pathophysiology, diagnosis, and management. Gastroenterology & Hepatology, 15(3), 179-190.
5. Colby, S. M., et al. (2020). Lifestyle factors affecting bowel health. Current Gastroenterology Reports, 22(8), 55.
6. Gastrointestinal disorders and aging. (2022). Journal of Gerontological Nursing, 48(4), 12-22.
7. Clinical guidelines for constipation management. (2021). American Journal of Gastroenterology, 116(7), 1239-1246.
8. Reid, P. P., et al. (2020). Impact of medication use on bowel function in elderly patients. Clinical Medicine Insights: Gastroenterology, 13, 1179551420901627.
9. Rao, S. S., et al. (2022). Advances in the management of refractory constipation. Gastroenterology, 162(4), 1030-1041.
10. Harrison’s Principles of Internal Medicine, 20e. (2018). McGraw-Hill Education.