CASE LEARNING OBJECTIVES
Identify the causes of constipation
Recognize the symptoms of functional constipation
Identify the goals of therapy for functional constipation
Recommend lifestyle modifications and therapeutic interventions for the treatment of functional constipation
"I'm constipated. I haven't had a bowel movement in 4 days, and this isn't the first time it has happened."
History of Present Illness
Quoba Nestor is a 48-year-old female who presents to her physician's office complaining of constipation. QN is evaluated every 6 months by her primary-care physician and was last seen 5 months prior to presentation. Upon further questioning by her physician, QN reported that she often has to strain when attempting to have a bowel movement. When she does have a movement, her stools are small, dry, and hard. She had used docusate in the past with some benefit, but recently it seemed to stop working. She has tried psyllium in the past, but she didn't like mixing it with so much water and it made her constipation worse. QN denied abdominal pain. QN has a history of HTN and neuropathic, joint, and muscle pain.
Neuropathic pain—radiculopathy caused by traumatic injury
Father is alive at age 72 and has CAD, HTN, osteoarthritis, and type 2 DM. Mother is alive at age 67 with type 2 DM, HTN, osteoarthritis, and hypercholesterolemia. QN has three siblings; all are living. Two siblings are known to have migraine headaches and HTN, and one sibling has type 1 DM.
QN is a divorced mother of two children aged 19 and 15. She works as a paralegal for the county government.
(−) Alcohol, tobacco, or illicit drug use
Allergies/Intolerances/Adverse Drug Events (ADEs)
Lisinopril 40 mg PO q day
Amitriptyline 50 mg PO at bedtime
Multivitamin 1 tablet PO every 24 hours
Ibuprofen 200 mg PO every 8 hours as needed for headaches and joint and muscle pain
Occasional headaches and joint and muscle aches and pains are relieved with ibuprofen; noticed a change in bowel habits when she started taking amitriptyline for neuropathic pain caused by traumatic injury; feels full
Well-developed, well-nourished middle-aged female in no acute distress
BP 120/80 mm Hg, P 70, RR 20, ...