Gastrointestinal Function Of A 74-Year-Old Black Woman

Gastrointestinal Functionrh Is A 74 Year Old Black Woman Who Prese

Gastrointestinal Function: R.H. is a 74-year-old Black woman presenting with complaints of bloating and persistent constipation over the past month. She reports infrequent bowel movements, sometimes only once a week, with stools that are hard and require significant straining to pass. She has undergone a recent colonoscopy with negative results, indicating no tumors or lesions. Additionally, she has experienced frequent heartburn occurring 3–4 times weekly, mainly at bedtime, which she manages with over-the-counter aluminum hydroxide. She also uses naproxen for arthritis, which causes stiffness in her hands and knees. Her decreased physical activity due to worsening arthritis may also influence her gastrointestinal health.

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Constipation is generally defined as a reduction in the frequency of bowel movements, typically fewer than three episodes per week, accompanied by hard, dry stools and difficulty in passing stool. It is a common gastrointestinal disorder that affects individuals across different age groups, but it is particularly prevalent among older adults due to a variety of physiological and lifestyle factors. Contributing factors include inadequate dietary fiber intake, insufficient fluid consumption, decreased physical activity, side effects of medications, and underlying medical conditions such as hypothyroidism or neurological disorders (Johanson & Kurland, 2016). Additionally, aging itself brings about changes in gastrointestinal motility, rectal sensation, and sphincter function, increasing susceptibility to constipation (Mearin et al., 2017).

Patients suffering from constipation can benefit from several recommendations to alleviate symptoms and prevent recurrence. Firstly, increasing dietary fiber intake through fruits, vegetables, whole grains, and legumes can improve stool bulk and facilitate bowel movements (American Gastroenterological Association [AGA], 2010). Adequate hydration is essential; patients should aim to drink sufficient fluids—at least 8 glasses of water daily—to soften stool consistency. Physical activity plays a significant role; encouraging regular exercise or walking can promote bowel motility (Johanson & Kurland, 2016). Establishing a consistent toileting routine, such as attempting bowel movements at the same time each day, can help train bowel habits. The use of over-the-counter laxatives should be approached with caution and only for short-term relief, as long-term reliance can impair normal bowel function. Medical evaluation is important if constipation persists despite lifestyle modifications, especially in older adults, to rule out secondary causes like metabolic or neurological disorders (Mearin et al., 2017). Monitoring and adjusting medications is also necessary since drugs like opioids, antacids, and NSAIDs may contribute to constipation.

In R.H. case, several signs and symptoms align with a diagnosis of constipation. The prolonged duration (one month), infrequent bowel movements (sometimes only once weekly), need for straining, and hard stools are characteristic features. Her description of taking at least ten minutes to initiate defecation further supports this. The fact that she feels relief after using over-the-counter remedies indicates functional constipation rather than an obstructive process. Additional signs compatible with constipation include sensation of incomplete evacuation, feeling of rectal fullness, and possible straining-induced hemorrhoids. Notably, she does not report pain during defecation or blood in stools, which could suggest other pathologies. Conversely, symptoms not yet present that might develop include abdominal distension, cramping, or altered appetite, which could hint at complications or more severe underlying issues.

Regarding anemia, it is a potential concern in patients with chronic constipation, especially if there is ongoing bleeding from hemorrhoids or internal lesions. Although R.H.'s recent colonoscopy was negative for tumors or lesions, chronic blood loss can sometimes occur from fissures, hemorrhoids, or other anorectal pathology, leading to iron-deficiency anemia. Given her age and history, it would be prudent to consider anemia if she exhibits symptoms such as fatigue, pallor, weakness, or shortness of breath. Laboratory assessments, including complete blood count and iron studies, would aid in diagnosing anemia. Therefore, although the current data do not explicitly indicate anemia, it remains an important differential diagnosis to monitor, especially considering her risk factors.

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