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Constipated Cases

This document presents a series of case studies concerning constipation in elderly patients, highlighting various underlying causes and treatment options. Each case focuses on different patient demographics and scenarios, such as those with immobility, pain, and medication interactions. Key considerations include the importance of bowel movement frequency, the implications of symptoms such as abdominal pain and stool characteristics, and the necessity for referrals or urgent interventions like colonoscopies. This resource is valuable for healthcare professionals managing constipation in geriatric patients.

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Constipated Cases

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  1. Constipated Cases Edward Warren, MD, Chair Geriatrics Carolinas Campus, January 2012

  2. Case 1 Your patient complains of constipation because her bowels move only every 2 to 3 days.

  3. Question 1 You tell her • If there is no pain nor straining, then this may be normal. • She needs an urgent colonoscopy. • Take large doses of laxitives every day. • She needs referral to a specialist.

  4. Case 2 You are seeing a 67 year old man who has had a marked decrease in bowel movement frequency to once every 5 or 6 days. They are painful and hard. The stools have also turned black. On exam fecal occult blood testing is positive.

  5. Question 2 You advise • Senokot S ii po bid • Colonoscopy to check for malignancy • 3 prunes for breakfast every day • 5 prunes for breakfast every day

  6. Case 3 • You are seeing an 83 year old lady who has cut way back on her fluids to help manage urinary incontinence. She is now constipated with hard stools.

  7. Question 3 You advise • Drink fluids anyway and let you help treat the bladder incontinence. • Take large doses of milk of magnesia daily. • Initiate a program of daily enemas. • Eat less food to cut down on the stools.

  8. Case 4 You are asked to see a 77 year old woman who just fractured her hip. She now is having constipation with no stool in 6 days and pain in the abdomen.

  9. Question 4 Causes of the constipation might be • Hydrocodone/APAP 5/325 q4h • Immobility from the fracture • Total lack of bowel meds in her regimen • All of the above

  10. Case 5 You are asked to see a 65 year old man who is writhing in pain. His bowels have not moved for a week. Today he began to have vomiting. The abdominal xray suggests dilation of the descending colon.

  11. Question 5 You diagnose • Constipation • Impaction • Urinary tract infection • Appendicitis

  12. Question 6 You feel a softball of hard stool in the rectum and give this urgent order: • Nurse to manually dig the stool out. • 30 ml MOM po now C. Docusate 100 mg po bid D. Encourage fluids

  13. Question 7 With my doctor a loud confrontation Engendered extreme consternation He’d treated me for a Severe diarrhea And now I’ve acute _________________

  14. Answers • A • B • A • D • B • A • Constipation

  15. Answers • If it ain’t broke, don’t fix it. • This is a red flag in a man over age 50. He needs to be checked for malignancy. • She has shot herself in the foot. You need to help address the primary bladder problem in a more effective manner. The other options would be harmful.

  16. Answers • All options are correct. You need to give a laxative to counter the opioid and get her mobilized some. • This is the picture of a bowel obstruction. It could be a tumor, but impaction is likely. None of the other choices would cause bowel dilation and vomiting.

  17. Answers • This is an impaction and will need to be removed. It is possible to irrigate an impaction out with a prolonged irrigating enema. • It’s a limerick, what can I say. Remember that constipation can present as diarrhea.

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