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

Gastrointestinal Functionrh Is A 74 Year Old Black Woman Who Prese

Define constipation and name the risk factors that might lead to develop constipation. List recommendations you would give to a patient suffering from constipation. Based on the clinical manifestations presented in R.H.'s case, identify and explain signs and symptoms compatible with constipation. Include additional signs and symptoms not present in the case. Consider the possibility of anemia as a complication of constipation based on the information provided.

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Constipation is a common gastrointestinal disorder characterized by infrequent bowel movements, difficulty passing stools, or a sensation of incomplete evacuation. The condition is generally diagnosed when an individual has fewer than three bowel movements per week, with the stools being hard, dry, and difficult to pass (Mullard & Palmer, 2018). Risk factors for constipation include age (particularly in the elderly), low dietary fiber intake, inadequate fluid consumption, sedentary lifestyle, certain medications (e.g., opioids, anticholinergics), ignoring the urge to defecate, physiological conditions such as hypothyroidism, and neurological disorders affecting gut motility (Camilleri et al., 2020).

Recommendations for a patient suffering from constipation encompass lifestyle and dietary modifications and, if necessary, pharmacologic interventions. Lifestyle suggestions include increasing dietary fiber intake (fruits, vegetables, whole grains), ensuring adequate hydration (at least 8 glasses of water per day), and engaging in regular physical activity to promote gut motility (Mullard & Palmer, 2018). Patients are advised to establish a regular toileting routine, responding promptly to defecation urges to prevent stool stagnation. When lifestyle changes are insufficient, over-the-counter laxatives such as fiber supplements, stool softeners, or osmotic agents may be recommended, but long-term use should be monitored to prevent dependency.

In R.H.'s case, clinical signs compatible with constipation include infrequent bowel movements—sometimes only once per week—straining during defecation, prolonged time (minimum of 10 minutes) to initiate a bowel movement, and hard stool consistency. The absence of pain during straining suggests the issue is constipation rather than an obstructive pathology. Additionally, her history of a recent colonoscopy negative for tumors or lesions rules out colorectal malignancy as an immediate cause. Symptoms not present initially but sometimes associated with constipation include bloating, abdominal discomfort, and a sensation of incomplete evacuation.

Regarding anemia as a complication, constipation itself rarely causes anemia directly; however, chronic constipation Can lead to secondary causes of anemia, such as iron deficiency. For example, if the constipation is associated with hemorrhoids or bleeding, it might result in blood loss leading to iron deficiency anemia. Although not explicitly reported in R.H.’s case, her hard stools and straining could predispose her to hemorrhoids or minor mucosal bleeding, which over time could contribute to anemia. The absence of blood in her stools and lack of other anemia signs such as pallor or fatigue suggests she may not currently have anemia, but ongoing blood loss from hemorrhoids or mucosal injury remains a theoretical risk.

In conclusion, early identification and management of constipation are essential to prevent complications. Lifestyle modifications remain first-line, with pharmacologic options employed judiciously. Evaluating for potential anemia and other complications as part of comprehensive care is advised, especially in elderly patients with chronic constipation (Camilleri et al., 2020).

References

• Camilleri, M., Parkman, H. P., Shafi, J., Abell, T. L., & Gerson, L. (2020). Chronic constipation. The New England Journal of Medicine, 382(17), 1572–1580. https://doi.org/10.1056/NEJMcp1913851
• Mullard, T., & Palmer, M. (2018). Constipation in adults: Pathophysiology and management. American Journal of Gastroenterology, 113(9), 1294–1302. https://doi.org/10.1038/s41395-018-0067-3