Chronic Constipation and
Weight: 95 lb
Changes in Weight: 5# weight loss in previous 2 months.
BMI: 19.1 (WNL)
Social hx: Married, Jewish, retired, lives at home.
Current medical diagnoses: Small bowel obstruction d/t
adhesions, chronic renal insufficiency, chronic
Past dx: B12 deficiency anemia, pure
hypercholesterolemia, chronic kidney disease stage
III, gastric ulcer, osteoporosis, depression, closed
Colles’ fx of right arm, hiatal hernia, breast cancer,
endometrial cancer, hypertension
Nutrition hx: Follows Kosher diet. Severe, chronic
constipation x 10 years.
Interrelationships of Medical Dx
Hypertension CKD Stage III
Increased Age Fluid Restriction Small Stature Mobility
Altered GI Function related to Chronic
Constipation/Obstipation as evidenced by
patient need to supplement with Colace,
Senna, and Glycerine suppositories to have a
normal bowel movement.
Inadequate oral intake related to poor appetite secondary to abdominal
distension and chronic constipation as evidenced by 25-50% intake at
meals per patient and dietitian.
Altered GI Function related to Small Bowel Obstruction as evidenced
by CT scan of pelvis/abdomen.
Back to this Nutrition Dx..
Altered GI function related to chronic
constipation/obstipation as evidenced by
patient needs to supplement with Colace,
senna, and glycerine suppositories to have a
normal bowel movement.
Is this normal laxative use?
What is Laxative Abuse?
Laxative abuse is the repeated misuse and overuse of
Dosing too frequently
Using laxatives for non-intended reasons (such as weight loss)
Using multiple types of laxatives at once
Using the wrong type of laxative (such as a purgative laxative
when a stool softener would have been appropriate)
Overuse can lead to dependency and a decrease in
Role of the Registered Dietitian
Identify patient’s bowel
Identify type and frequency of
Be specific – patients will not always
willingly offer this information.
Check labs, electrolytes, and
Monitor for disordered eating
patterns or disordered bowel
Appropriate treatment for eating disorders
Goals of treatment:
Stop laxative abuse
Maintain healthy GI Function
Labs and other nutritional parameters
Is this patient abusing laxatives?
YES. But, is it an eating disorder, or is she just
an older adult with constipation?
Rigid bowel regimen
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