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.
1. In your own words, define constipation and name the risk factors that might lead to developing constipation.
2. List recommendations you would give to a patient who is suffering from constipation. Include both pharmacological and non-pharmacological.
3. 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.
4. Complement your list in question 3 with other signs and symptoms of constipation not present in the case study.
5. Sometimes Anemia can be present as an associated diagnosis and/or a complication for patients with constipation. Would you consider that possibility based on the information provided in the case study? Explain.