STU Wk 5 Constipation Gastrointestinal Problem that Affects Old People Response

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Milien, Cassandre

Nov 14, 2020 at 20:37

Gastrointestinal Function

One of the most common problems among older people is constipation. It is not a disease, but it is a symptom that the intestinal function is not adequate. However, it is not usually treated appropriately because those over 60 consider this alteration in their intestinal transit to be normal, and they try to fix it themselves, or they don’t consult with their doctor. Constipation is medically defined less than three stools per week and severe constipation as less than one stool per week. It can become a problem if it is a symptom of underlying conditions, such as colorectal cancer, or if it starts to cause further damage (Sampson, 2019).

Risk Factors that may Be Contributing to Constipation

Risks factors that are attributed to constipation are: aging, medications, a diet lack of fiber, physical inactivity, gender and pelvic floor dysfunction. Ms. R.H is 74 years’ old women who is at risk to constipation since the gastrointestinal mucosal muscles are incompetent as there is an aging deterioration process (Rao, Rattanakovit & Patcharatrakul, 2016). Certain medications can also increase the risk of constipation. This is a common side effects for medications such as NSAID, opioids, diuretics, iron and antacids. R.H is taking naproxen for the management of arthritis, but the side effects of medications such as naproxen are constipation, and gastrointestinal system upset (Wald, 2016). Also, she is taking aluminum hydroxide. Antacids containing aluminum and calcium cause constipation since they reduce bowel movement (Barbara, 2020). A diet with lack of fiber and low hydration is a third risk factor associated with constipation. Overconsumption of foods that is rich in eggs, high-fat meats, dairy as well as sugar-containing sweets can cause heartburn and constipation. Low levels of physical activity may also lead to constipation. R.H indicates stopped her daily walks due to her worsening arthritis. People who spend several days or weeks in bed or sitting in a chair may have a higher risk of constipation especially among older adults. Pelvic muscle weakness and other muscle function problems are a major contributor to constipation. The muscles in our pelvic floor have to work in a very particular way in order for stool to move through the rectum (Lee, 2020). As compared to the males, the females are more likely to experience pelvic floor dysfunction due to the history of pregnancies.

Clinical Signs and Symptoms that are Consistent with Constipation

Ms. R.H presents multiple clinical signs that are associated with constipation. Some of the signs she reported that are consistent with constipation include straining to initiate bowel movement. Complains of feeling bloated is also a symptom of constipation (Rao, Rattanakovit & Patcharatrakul, 2016). She has also complained about experiencing only one bowel movement for an entire week. Her stools have also been extremely hard. The use of three pillows to sleep well indicates that she has been experiencing abdominal pain and heartburn which are also an indication that there is a gastrointestinal upset as a result of constipation (Wald, 2016).

Why is Anemia Not a Suspected Complication of this Condition?

In my opinion, anemia can be ruled out in R.H. visit because she did not report any clinical sign that could be linked to anemia. Anemia is mostly caused by active bleeding and iron deficiency which is not a present condition for the patient. The most probable complications for constipation that can lead to bleeding would be hemorrhoids, fecal impactation, rectal prolapse and anal fissure. In the case of R.H during her visit she did not report bleeding during stooling, due to hemorrhoids, or tarry stools, due to upper GI bleeding.

Would a Urinalysis, Series of Liver Function Tests, or Serum Uric Acid Level Be Appropriate for this Patient?

As I mentioned in the introduction constipation is not a disease, but it is a symptom and yes, those additional test will be appropriate for R.H. to rule out the presence of any health complication that may be hidden or associated with her constipation (Wald, 2016). Patient with constipation can suffer of recurrent UTI due to the pressure that the stool accumulated in the colon exert on the bladder. The serum uric acid level can help to differentiate if she has gout or rheumatoid arthritis that is a disease that can also slow down the function of the intrinsic nerves and muscles of the colon causing severe constipation. Furthermore, the liver function tests are necessary to identify any form of complications associated with poor hydration status of the patient (Rao, Rattanakovit & Patcharatrakul, 2016).

Reference

Barbara, B. (2020). Causes and risk factors of constipation. Verywellhealth. https://www.verywellhealth.com/constipation-causes-1944788 (Links to an external site.)

Lee, L. A. (n.d.). Constipation: Causes and Prevention Tips. https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipation-causes-and-prevention-tips (Links to an external site.)

Rao, S. S., Rattanakovit, K., & Patcharatrakul, T. (2016). Diagnosis and management of chronic constipation in adults. Nature Reviews Gastroenterology & Hepatology, 13(5), 295.

Sampson, S. (2019, November 13). What to know about constipation? https://www.medicalnewstoday.com/articles/150322#symptoms (Links to an external site.)

Wald, A. (2016). Constipation: advances in diagnosis and treatment. JAMA, 315(2), 185-191.