Constipation, Case Study Example

During my practicum experience, I interviewed an 8 year old male who reported “tummy problems” that were interpreted as gastrointestinal distress. During the initial interview I asked whether it hurt when he tried to go to the bathroom, the last time he went to the bathroom, how many glasses of water he had in the last day, the food he ate in the last day, and if he noticed pain anywhere else. The patient was able to answer a majority of the questions himself, but I asked his mother about the amount of water he drank and his diet over the past 24 hours to confirm that the patient had remembered adequately. The boy responded that he had been able to urinate that day but had no bowel movements, the last time he had been able to move his bowels was the day before, and he was having a minor headache. In addition, he reports that he had about 8 glasses of water, skipped breakfast, had soup for lunch, and ate steak for dinner.

To determine the intensity and precise location of the patient’s abdominal pain, I performed an abdominal examination (Alcantra et al., 2014). During the exam, I looked for signs of distension in the ascending, descending, and sigmoid segments of the colon. I then asked him how long it was hurting like this, and he responded that it had been going on for about a day. As a consequence, I was able to rule out irritable bowel syndrome, because in this disorder pain typically persists for at least a few months (Self et al, 2014).

Although the boy seemed to be in a moderate level of pain (about 5-6), after ruling out irritable bowel syndrome, it was most likely that he has constipation and would be able to reverse his pain simply. While he appears to be drinking enough water on a daily basis, it is important to have a conversation with his mother about his diet. It is essential for a young boy to not skip breakfast and to prevent constipation in the future, it is recommended he be given a cereal with high fiber content. In addition, the boy had not eaten many vegetables or leafy greens; his family should ensure that this is a part of his diet as well.

The symptoms of constipation include infrequent bowel movements, swollen abdomen or abdominal pain, and nausea. Although the patient didn’t report nausea during the interview, it is likely that this symptom was present to some extent because he voluntarily skipped breakfast. As a consequence, it is clear that this is the problem he is experiencing because he fits the description of the disorder appropriately.

As mentioned previously, this constipation episode is likely a consequence of the patient’s diet; poor fiber intake is related to this problem. It is recommended that the patient eat foods with high fiber to resolve the problem long-term and take a stool softener to resolve the pain short term (Burness et al., 2014). The patient should return to the clinic if he experiences these symptoms again because it will mean there is a deeper hormonal problem. This test will not be performed at this initial visit because a hormone imbalance is unlikely at his young age. If and when the pain returns, the tests that will be performed include blood tests for hormonal imbalance is suspected, Barium studies to look for obstruction of the colon, and possibly a colonoscopy to look for obstruction of the colon (NA, 2013).

References

Alcantara J, Alcantara JD, Alcantara J. (2014). An integrative review of the literature on the chiropractic care of infants with constipation.Complement Ther Clin Pract, 20(1):32-6.

Burness CB, Keating GM. (2014). Oxycodone/Naloxone Prolonged-Release: A Review of Its   Use in the Management of Chronic Pain While Counteracting Opioid-Induced Constipation.Drugs. [epub].

(2013). [Algorithm of diagnosis and management of patients with the syndrome of chronic constipation. In the help to practitioner].Eksp Klin Gastroenterol, (5):102-7.

Self MM, Czyzewski DI, Chumpitazi BP, Weidler EM, Shulman RJ. (2014). Subtypes of Irritable Bowel Syndrome in Children and Adolescents.Clin Gastroenterol Hepatol, S1542-3565(14):00139-6.