Disorders of the Gastrointestinal System, 2nd Edition
66
When a person does not drink enough fluids, more fluid is absorbed from the in - testine, and stools become hard and dry. Adequate hydration and a diet high in fi - ber cause water to be pulled into stools by osmosis, thus keeping stools soft and facilitating their movement through the intestine (Basson, 2020). Common causes of constipation in- clude (Basson, 2020): ● Low-fiber diet. ● Lack of exercise or limited ability to be physically active. ● Certain medications, such as opiates, iron supplements, and antacids, interfere with bowel motility. ● Conditions or injuries that interfere with neural pathway functioning, such as head injury, multiple sclerosis, stroke, and Chagas disease. ● Metabolic and endocrine disorders, including diabetes mellitus. ● Overuse or abuse of laxatives. ● Overuse of enemas, which reduce rectal sensitivity to the presence of stool. ● Dehydration. ● Diseases or abnormalities of the colon or rectum, such as anal fissures or rectal cancer. ● Ignoring the urge to have a bowel movement. ● Stress. ● Neurological problems such as Parkinson’s disease and Hirschsprung disease. ● Spinal cord injuries and neurogenic bladder. ● Conditions that affect the size and shape of the bowel, such as cancer, strictures, hernias, and adhesions. ● Connective tissue diseases such as scleroderma and amyloidosis.
| NURSING ALERT
Many medications affect GI function - ing. Certain blood pressure medica- tions such as calcium channel block- ers, antidepressants, anti-Parkinson drugs, iron supplements, anticonvul- sants, antiemetics, and antispasmod- ics may also cause constipation in some patients (Basson, 2020).
| NURSING CONSIDERATION
Older adult patients generally experi- ence reduced intestinal motility and a slowing of neural impulses in the gas- trointestinal tract, which can increase the risk of constipation. This same population often limits the amount of fluids they drink to avoid or reduce incontinence, and they suffer from co- morbid conditions. Inadequate fluid consumption also increases the risk of constipation and dehydration. Pa- tients with limited physical activity be- cause of age or illness are also at risk for constipation (Rao, 2022). A history of dry, hard, infrequent bowel movements suggests an inactive colon. A thorough history and physical must be conducted to rule out serious disease pro- cesses such as malignancies (Rao, 2022). Testing stool for occult blood, a rectal exam, an upper GI series, barium enema, and colonoscopy may be performed. If other conditions are ruled out, a marker exam may be performed during which the patient swallows a capsule. The prog- ress of the capsule is tracked through the GI system to identify how long it takes for the passage of stool, as well as if there are any areas where significant slowing of the
Powered by FlippingBook