Assessing The Discomforts Of Constipation
This article relays pertinent information regarding assessing constipation by studying the diet, and some physical attributes.
A comprehensive bowel function history should be conducted with the individual that encompasses a determination of his/her usual bowel pattern. Many factors contribute to constipation, so additional data should be collected related to the individualís cognition and affect; nutritional status, including any dysphagia, state of dentition, diet and fluid intake; level of mobility; and laxative use and current medications, with particular attention paid to those medications associated with constipation. This article relays pertinent information regarding constipations, how it is reviewed in ones diet, how it is physically or radiologically examined, what are the stool characteristics, and how the process of aging contributes to constipation.
A review of the personís diet (e.g. completion of a 3-day calorie count) should be done to evaluate the diet for nutritional content. No literature was found that recommend weighing individuals to assess for presence of constipation or to evaluate the effectiveness of interventions. However, weighing the individual at regular intervals may provide further corroboration of the adequacy of the individualís nutritional intake. Identification of predisposing disease states, such as neurogenic disorders and metabolic or endocrine diseases, is also important.
A physical examination should be performed as part of the assessment for constipation. Particular attention should be paid to the abdominal examination (including inspection, auscultation of bowel sounds, percussion, and palpation of the abdomen) to assess for impaction, presence of abdominal masses, tenderness, and/or rigidity. A digital rectal examination is used to assess anal sphincter tone and to detect hemorrhoids, fissures, rectal prolapsed, feces, and rectal masses. Individuals with chronic constipation may also require a barium enema, colonoscopy, defecography, anorectal motility, or colonic transit studies. A physician should be consulted if there is an increase or decrease in the frequency of the individualís bowel sounds, if the individual has signs or symptoms of bowel rupture and/or peritonitis (e.g. fever, rigid abdomen, persistent abdominal pain), or if the individualís constipation or fecal impaction persists after nonpharmacologic and pharmacological interventions.
Constipation is characterized by bowel movements that are more infrequent than usual for the individual, bowel evacuation that may be difficult or painful, and/or a digital rectal examination that indicates the presence of stool in the rectum that may be hard and dry or soft and puttylike. The assessment may also reveal fecal impaction, which is characterized by decreased appetite, nausea, vomiting, and abdominal pain, and distention. Depending on the location of the impaction, there may be feces in the rectum (hard or soft and puttylike) on digital rectal examination.
Some individual groups are more likely to experience constipation. Constipation is prevalent among elderly persons for a variety of reasons. The aging bowel has anatomical changes (e.g. presence of diverticula that contribute to uncoordinated colonic muscle contraction) and pathophysioogical changes (e.g. diminished contractile muscle tone and loss of neuronal sensitivity) that make defecation more difficult. The elderly person who has faulty eating habits, decreased food intake, or delayed response to the urge to defecate is also at greater risk for constipation.