Constipation - Clinical Presentation of the Disease - Research Paper Example

Evidence Based Practice Paper on Constipation Evidence Based Practice Paper on Constipation Health and safety is regarded as one of the most important aspects of human life, irrespective of the domain of the society to which an individual belongs. In today’s contemporary social setting, people are quite busy with their daily work to earn better livelihood for themselves. However, in between the extreme pressure, individuals have to deal in their personal and professional lifestyle needs, they seldom get time to maintain a proper lifestyle that keeps them away from diseases and health complications. In consequence, it is apparent that thousands of dollars spent every year all over the world in order to deal with the issues associated with health complications of people. The increased number of chronic and life-threatening diseases further imposes vulnerable impacts on the balance of the society. Constipation is one of the common diseases currently prevailing within the society. It is caused owing to the infrequent bowel movements and/or difficulty having bowel movements in certain cases. Some of the signs and symptoms of this particular disorder include swollen stomach, stomach pain in certain cases, decreased appetite, lethargy and vomiting tendencies among others. It will be vital to mention that the bowel movements in humans differ from person to person and contextually, the time of the same may varies. However, in usual scenario, the substances of human intestines get hardened owing to inappropriate bowel movements for more than three days, which certainly results in constipation (Patients.co.uk, n.d.). Problem: Definition and Epidemiology The problem of constipation is emphasized in this particular discussion, concerning its prevalence amid the elderly people. Observably, people in the older age are deemed to be quite vulnerable towards chronic and life threatening health complications. Additionally, they also need to deal with various health issues, which are although not chronic but it certainly affects the day-to-day wellbeing of the people in the society. Among these daily health issues suffered by people, the complications resulting from ‘Constipation’ can be considered as among the basics. It is often known as the ‘bowel movements’ that are quite irregular in nature. The timing of bowel movement in humans differs from person to person. It would be vital to mention that some people might come across with bowel movements three times while it might differ in the case of others and might be recorded even 1 or 2 times a week in specific individuals. However, in usual scenario, three days without bowel movements is quite likely to result in constipation (Patients.co.uk, n.d.). Epidemiology of the Disease In order to understand the chronicity of the disease among elder people, it will be vital to comprehend the causes, patterns along with the effects of this particular medical condition on the elderly people who are also the target population for this particular research study. The patterns of the disease among the elderly or mature adults are quite irregular and fluctuating as it differs from person to person. In usual cases, the faeces of the humans become hard, which further ensures painful effects while passing the faeces from the body. Furthermore, in general scenario with elderly adults, the usual pattern of bowel is 2-3 times a week, while 2-3 times a day is also considered normal as per medical understanding. However, a change in this daily or usual pattern of bowel movements might clearly depict that the patient is constipating (Patients.co.uk, n.d.). There are also instances when elderly people experience pain in the lower abdomen of their stomach, which again can be a result of constipation. The causes of constipation might be diverse and distinct in nature, which might also differ from person to person on the basis of their age or physical health. Lack of adequate fibre in the food one consumes is one of the basic and the most potential cause of such health complications. Fibre is the substances derived from plant foods. As it remains undigested, it helps the faeces to become bulk so that the bowel movements of the body remain appropriate and stable. However, the improper or inadequate intake of these substances is quite likely to work negatively for the body (Patients.co.uk, n.d.). Inadequate intake of liquid food or water might also result in constipation. It is believed that drinking adequate fluid softens the faeces that in turn certainly help in proper bowel movements, which consequently avoids constipation. Certain medical conditions among individuals might also be a potential cause for such health complications to occur. People dealing with health issues, such as thyroid, gut disorders and ‘irritable bowel syndrome might also be a potential cause of such diseases (Patients.co.uk, n.d.). Pathophysiology of the Disease In this particular section, the pathology as well as the physiology of constipation on the elderly people will be discussed. It is often deemed that the process of maintaining normal defecation among the elderly people is quite complex as it requires proper ‘rectal filing’ along with the ability to propel the faeces, which is again quite unusual for patients with increasing age. It will be crucial to mention that there are several key factors, which needs to be ensured while assuring normal execution of faeces from the human body to avoid constipation. In majority instances, these key causes are often quite tough to be diagnosed among elderly people. On the basis of pathophysiology, the causes of constipation can be categorised into primary and secondary reasons. The primary causes of the disease commonly include normal transit, slow transit and evacuation disorder among others, while the secondary causes include medications, metabolic, neurological and psychiatric reasons among others. Normal-transit constipation is one of the most common types, where patients usually report signs that are quite parallel with constipation, which implies hardening of the stools along with difficulty in the process of evacuation of the same. The patients suffering from this particular condition have to deal with abnormal pain on the abdomen along with discomfort, which is again a result of ‘irritable bowel syndrome’. This condition will further result in extreme psychological distress in most of the cases (Andrews & Storr, 2011). ‘Slow transit constipation’ usually results owing to ‘infrequent bowel movements’, which is seen to be quite common among young women, but are rare in cases of elderly people. Such situation arises when the bowel movements in individuals become quite irregular and infrequent with less than once a week of bowel movements in some of the cases. Observably, individuals dealing with such kind of constipation will not assume the need to defecate and therefore, it might result in abdominal discomfort. The timing of the colonic transit with such patients is quite lengthy along with a considerable reduction in the frequency of the HAPC’s (Andrews & Storr, 2011). ‘Defecation or Evacuation Disorders’ is a group of abnormalities, which include both anatomical as well as functional disorders, which further gives rise to signs of constipation. It will be crucial to mention that patients who are suffering from this sort of disorder will show significant straining and will usually spend a considerable amount of time regularly in toilet. It has also been analysed that patients suffering from such sort of constipation will also face difficulties while evacuating the liquid faeces from the body. Some of the common causes of this kind of constipation include ‘structural abnormalities’ and ‘descending perineum syndrome’ among others (Andrews & Storr, 2011). There are also certain secondary causes or types of constipation that were described in the earlier sections of the paper. In this regard, drug intake also sometimes leads to constipation. People who are involved with constant intake of drugs or medicines are highly vulnerable towards constipation. Drugs, such as clonidine and ganglionic blockers, have the potential to cause constipation. Notably, ‘oral iron supplementation’ that associates with patients having iron deficiency might also result in constipation. This depicts the role of medicines as a causal agent for improper health conditions, such as constipation. There is a strong relevancy amid ‘neurological disorder’ and constipation. Observably, disease that associates with the nervous system might lead to serious constipation. These diseases might be ‘diabetes mellitus, ‘endocrine diseases’ and ‘autonomic neuropathy’ among others (Andrews & Storr, 2011). Clinical Presentation of the Disease The signs and symptoms of this particular disease are quite vital to depict in order to determine the measures or the medical treatment required to deal with the same. The signs and symptoms of this particular disease will also be significant to analyse, for the targeted patients i.e. elderly people. This can be done with the help of the OLDCART tool. OLDCART refers to Onset, location, duration, characteristics, aggravating factors, relieving factors and treatment. This is a particular framework where patients are analysed in a systematic manner in order to depict the present scenario of their health conditions with regard to the disease they are dealing with. This tool will also be helpful in depicting the health conditions of the patients suffering from constipation within the targeted population, i.e. people in their old age (Hsieh, 2005). In the first stage of the OLDCART process, i.e. Onset, the patients are asked to describe about how, when and where the pain began in the body. Analysis depicts that when suffering from constipation, elderly people experience pain when the bowel movements of an individual become infrequent. This pain mainly develops where the faeces in the human body becomes hard, which results in difficulty in evacuation. The pain might also cause severely owing to the difficulty in defecation (Hsieh, 2005). In the second step of the process, as per the OLDCART pain assessment tools, patients are asked about the location of the pain and if the pain takes place in more than one location. In this regard, the targeted patients might depict that the pain usually locates in the abdomen owing to the inappropriateness in the bowel movements. Sometimes it might also been seen that people, especially including the elderly, who are suffering from constipation, deal with extreme abdominal pain, which also results in swollen stomach. The location of the pain tends to change in scenarios when the stools of the patients become quite hard, which are difficult to pass from the body and ultimately causes staining (Hsieh, 2005). In the next stage of the OLDCART process, patients are asked about the duration of the pain and how often they tend to occur. This step of the assessment also depicts about how long the pain exists. Patients who are dealing with this particular heath issue, also depicts that their gut transit process takes considerable period of time. Patients with such illness also reports that they need to spent a lot of time in toilets. Moreover, the duration of their evacuation is also reported to be longer as compared to normal patients. In some of the cases, bowel movements, which are primary reasons for proper stool evacuation, becomes infrequent may reach to only 1 time a week in certain cases. It will be crucial to mention that with the increase in time in defecation, the pain for the patients will also increase (Hsieh, 2005). Subsequently in the OLDCART process, patients are asked about the characteristics of the pain that arise owing to constipation. In this regard, patients might depict that the pain is quite severe in nature. This is mainly the pain experienced while facing difficulties in defecation (Hsieh, 2005). As per the OLDCART process, the next step will be to depict the aggravating factors that may cause the pain to get worse. In this regard, the possible responses of the targeted population will be the use of stool softening tools that might worsen the pain in the elderly patients. This is because of the fact that the softeners are deemed to be effective for patients with ‘anal fissures or hemorrhoids’, which is quite rare with elderly patients (Hsieh, 2005). In sequence, the next step of the OLDCART process identifies the relieving factor for the patients. In this regard, the responses of the patients might include the use of Bulk Laxatives such as “psyllium, pectin, or guar” that increases the weight of the stool, which again helps to improve the efficiency of evacuation, further decreasing the chronicity of pain experienced by the patients. In the last step, proper treatment will need to be suggested for the patients. In this regard, it can be suggested that the patients will get involved in the intake of more and more fibre in their diet. They should also involve in regular exercises to deal with their vulnerability towards a particular disease (Hsieh, 2005). Differential Diagnosis in Constipation Observably, differential diagnosis is the method that is primarily used for finding the most probable diseases from the signs and symptoms arising for particular patients. Notably, this particular process analyses the signs and symptoms from various different perspectives, finally reaching a conclusion where one particular diseases is considered more probable for which the further medical tests are conducted. Some of the different forms of differential diagnosis implemented for analysing conditions of constipation include irritable bowel syndrome (functional constipation), pelvic floor muscles (floor constipation) and colonic function (primary constipation) among others. Irritable bowel syndrome is depicted to be one of the major causes for constipation for all groups of people including the aged one. Notably, bowel movements is one of the most important aspects that is directly associated with the normal process of stools defecation. Apparently, proper bowel movements (which differ from person to person in terms of their age, gender and physical condition) can be recorded twice a day, thrice a day or even twice a week in certain cases. However, if the bowel movements among the elderly patients is observed as once a week, then the stools are likely to get harder, which can result in difficulties while defecation. Again, such pain or discomfort in the abdomen, bloating or considerable change in the bowel movements habit of people are potential signals of bowel syndrome, which certainly results in constipation. The detection of the IBS condition can also be made with the help of certain other conditions including “unexplained weight loss of the elderly patients” and bleeding in the rectal area, which again can be depicted as potential symptom of IBS. During diagnosis of constipation, symptoms of IBS, including anaemia, rectal masses as well as abdominal masses are also detected and the treatment are designed accordingly for the symptoms of the bowel, which will further be able to cure Constipation (NICE, 2008; Abi-Hanna & Lake, 1998). Differential diagnosis for the cause of constipation also includes ascertaining or detecting the symptoms of irregular behaviours in pelvic floor muscles, which are again potential reasons for constipation in many cases relevant to the elderly patients. The ‘pelvic floor muscles’ are firmly hanged amid the “tailbone (coccyx) and the pubic bone” that has a significant role in supporting the bowel, uterus and the vagina (State Government of Victoria, 2014). Observably, if these are weekend, the internal organ of the body will no longer be supported, which again leaves a major risk of acute constipation among elderly people. Notably, the dysfunction of the pelvic floor muscles may hinder the evacuation from the body in a complete manner. This is again accompanied by sensation in the rectum area, which is again owing to incomplete emptying of the stomach through urination or stools through bowel movements. This aspect further gives rise to situation, which makes it apparent that patients are dealing with chronic constipation. It has been noted in this regard that to deal with chronic constipation, retraining of the ‘pelvic floor muscles’ will be helpful in clinical approach. Observably, more than 50% of elderly patients suffering from constipation are diagnosed with ‘pelvic floor dysfunction’. Hence, treatment to retrain the ‘pelvic floor muscles’ will ultimately be a potential measure to help recover elderly patients suffering from constipation (Mayo Clinic, 2014). Differential diagnosis for constipation also includes the analysis of colonic function. Observably, the colon is the concluding part of the digestive system of an individual. Its role includes extracting the water along with the salt from the remains of the food prior to their final elimination from the body through evacuation. “Dysmotility of the colon” is also depicted to be among the major reasons for ‘slow transit constipation’ among the elderly patients. Dysmotility is a particular condition among the patients where their digestive system or the muscles associated with it reduces, which again results in bloating and vomiting. This scenario is also termed as ‘abnormal intestinal motility’. This irregularity in the motility further has the potential to cause constipation among most of the elderly patients (ASCRS, 2014). As can be observed from the above discussion, there are various forms of differential diagnoses involved with the patients of constipation in all age groups. Apparently, this differential diagnosis has certain similarities and distinctness amid themselves. It will be vital to mention that all the three differential diagnoses mentioned in the earlier section of the discussion can potentially lead to constipation along with other chronic health issues. Furthermore, all the three can also be found as interrelated to each other. For example, the ‘dysmotility of the colon’ might lead to the infrequency of the bowel movements, which potentially gives rise to constipated situations. Correspondingly, the irritable bowel syndrome also leads to the dysfunction of the pelvic floor muscles, which are inclined to accompany with constipation amid the patients. However, these conditions might differ in terms of their severity and mode of clinical treatment. Amid the three differential mentioned in the previous section, the dysfunction of the pelvic muscles might accompany with chronic constipation while the other two has marginal role in causing constipated situations amid the patients (Hsieh, 2005). Diagnostics Different sort of diagnostics are used for the detection of the three disorders mentioned above that might also lead to constipation. In this regard, it has been noted that in order to depict IBS in an individual, medical examiner might ask the patients to conduct several tests, which includes ‘Flexible sigmoidoscopy’, ‘Lactose intolerance tests’ and Blood tests among others. The examination will mainly be concentrated towards depicting the bowel condition of the patients, which usually seems healthy but do not function well in case of IBS. However, if the elderly patients reports abdominal pain lasting for about 12 weeks, the disease can be ruled in. Also, incomplete bowels in most of the cases may also rule in the disease without the need for conducting any further tests (Abi-Hanna & Lake, 1998). The diagnostics that will be required for the examination of the Dysmotility of the colon will need to be fully equipped to conduct tests including Colonic barostat testing, Colon motility testing and Colonic transit testing among others. These tests will allow the doctors to visualize the colonic transit as well as conditions of the muscles. Depiction of “abnormal colon contractions” and “Dysfunctional innervation of colonic” will rule in this particular health complication (Mayo Clinic, 2014). Diagnosis of Pelvic floor dysfunction’ will also require laboratories that are well equipped to conduct tests such as ‘defecating proctogram’,‘uroflow test and’ video X-ray among others. These tests will allow the physician to depict the present condition of the pelvic muscles. If the flow of urine of the patients shows irregularity as compared to the normal condition, the disease can be ruled in with such patients (Cleveland Clinic, 2014; California Pacific Medical Center, 2013). Management/Treatment of the Disease The discussion in the previous sections of the paper includes several aspects including the causes of constipation, the signs and symptoms of the disease and the process and the criteria for diagnosis among others. This section of the research study will correspondingly deal with the treatment or management of constipation among elderly patients. The first step of the treatment plan of the elderly patients will firstly include acquiring the mediation and basic lifestyle history of the patient. For chronic constipation of the elderly, the first step of the treatment will include increasing the fibre in the diet of the patients. This will result in increasing the weight of stool, which will further reduce the colon transit timing and will ultimately lessen the difficulty during evacuation. The implementation of the laxatives, such as ‘magnesia, lactulose and senna compounds’ will potentially work positively towards curing the disease. This is expected to enhance the consistency as well as frequency of the stool, which will again be a potential treatment of the disorder among the elderly people. Stool softeners as well as suppositories are also deemed to be clinically effective as this might help with the ‘rectal evacuation’. In the modern day scenario, ‘Lubiprostone’ is also an important agent that can be implemented for the treatment of constipation. It is an ‘oral bicyclic fatty acid’, which works towards activating the chloride channels and can be regarded as a potential measure to enhance the evacuation process (Rao & Go, 2010). Again, the use of Psyllium such as Metamucil as well as Konsyl also has positive results for elderly patients suffering from this disease. The anticipated result for the implementation of this agent may include improving the stool frequency of the elderly patients. Osmotic Laxatives such as ‘Polyethylene glycol (PEG)’ are also among the important agents that work towards increasing the consistency of the stools amid the elderly patients suffering from this particular disorder. Herbal supplements can also be used as effective measures for the treatment of the chronic constipated patients as it improves the efficiency of the evacuation process (American College of Gastroenterology Chronic Constipation Task Force, 2005). Regular exercise will also be considered as a potential measure in the management of this particular disease. Observably, low level of physical activity is also depicted to be a potential risk for the augmentation of constipation among the elderly patients. In this regard, regular physical exercise will result in minimising the vulnerability towards the disease. This is also regarded as a potential measure for the management of the diseases (Hsieh, 2005). Conclusion From the overall analysis of the paper, it can be comprehended that health and safety are among the most vital aspects of the lives of the people. With the increasing number of diseases and health disorders, the wellbeing of the people living in the society is under severe threat. In this regard, among various disorders that unfavourably imposes serious impacts on the daily activities of the people, constipation is deemed to be one of the basic and prime health disorders. It is a particular health disorder where, in general, the stool of the patients gets hardened and further hinders the frequency and completeness of the bowel movement. This particular disorder is quite common among the elderly people as they become vulnerable towards the causes of this disease with the increase in their age. Hence, it can be concluded that it can be conveyed that there are various potential causes of constipation and the treatment conducted for the disease is on the basis of the evidence acquired from test and diagnosis. References ASCRS. (2014). Pelvic floor dysfunction. Retrieved from http://www.fascrs.org/patients/conditions/pelvic_floor_dysfunction/ American College of Gastroenterology Chronic Constipation Task Force. (2005). An Evidence-Based Approach to the Management of Chronic Constipation in North America. American Journal of Gastroenterology, 100 (1): 1-22. Abi-Hanna, A., & Lake, A. M. (1998). Constipation and encopresis in childhood. Pediatrics in Review, 23-32. Andrews, C. N., & Storr, M. (2011). The pathophysiology of chronic constipation. Canadian Journal of Gastroenterology, 21: 16-21. Cleveland Clinic. (2014). Diseases & conditions. Retrieved from http://my.clevelandclinic.org/disorders/pelvic_disorders/hic_pelvic_floor_dysfunction.aspx California Pacific Medical Center. (2013). Complex digestive disease center - gastrointestinal motility service. Retrieved from http://www.cpmc.org/services/gi/services/lowergut.html Hsieh, C. (2005). Treatment of Constipation in Older Adults. American Family Physician, 72 (11): 2277-2284. Mayo Clinic. (2014). Irritable bowel syndrome. Retrieved from http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/tests-diagnosis/con-20024578 Mayo Clinic. (2014). Retraining pelvic floor muscles to correct chronic constipation. Retrieved from: http://www.mayoclinic.org/medical-professionals/clinical-updates/general-medical/retraining-pelvic-floor-muscles-correct-chronic-constipation NICE. (2008). Irritable bowel syndrome in adults. Retrieved from http://www.nice.org.uk/nicemedia/live/11927/39622/39622.pdf Patients.co.uk. (n.d.). Constipation in adults. Retrieved from: http://www.patient.co.uk/health/constipation-in-adults-leaflet Rao, S. S. C. & Go, J. T. (2010). Update On The Management Of Constipation In The Elderly: New Treatment Options. Clinical Interventions in Aging, 163-171. State Government of Victoria. (2014). Pelvic floor. Retrieved from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_floor?open Read More