Chronic Constipation and
Laxative Abuse
LAURA HUTCHINSON
DIETETIC INTERN
BENEDICTINE UNIVERSITY
Patient Profile
 Age: 84

 Gender: Female
 Race: Caucasian
 Height: 4’11
 Weight: 95 lb
 Changes in Weight: 5# weigh...
Patient Hx
 Past dx: B12 deficiency anemia, pure

hypercholesterolemia, chronic kidney disease stage
III, gastric ulcer, ...
Interrelationships of Medical Dx
Hypertension  CKD Stage III


Anemia

Osteoporosis



Increased Age Fluid Restric...
Nutrition Diagnoses
 Altered GI Function related to Chronic

Constipation/Obstipation as evidenced by
patient need to sup...
Back to this Nutrition Dx..
 Altered GI function related to chronic

constipation/obstipation as evidenced by
patient nee...
What is Laxative Abuse?
 Laxative abuse is the repeated misuse and overuse of

laxatives involving






Dosing too ...
Types of Laxatives
 Bulk-Forming Laxatives
 Saline Laxatives
 Osmotic Laxatives
 Surfactant Laxatives 
 Lubricants
...
Profile of a Laxative Abuser
 Eating Disorder patients






Histrionic personality traits
Lower self-esteem
Lower “...
A Vicious Cycle
–with
dehydration, the
reninangiotensin
system kicks in,
following by
rehydration and
water weight
gain

C...
Electrolyte
Disturbances

Metabolic
Disturbances
Bowel
Disturbances 
Kidney
Disturbances

Complications
(Roerig, Cummings...
Diagnosis
 Practitioner’s suspicion
 Melanosis Coli
 GI symptoms
 Serum hypokalemia
 Fecal electrolytes
 Stool osmot...
Role of the Registered Dietitian
 Identify patient’s bowel

patterns.
 Identify type and frequency of
laxative use.


B...
Treatment/Monitoring
 Education
 Appropriate treatment for eating disorders
 Risks?
 Goals of treatment:
 Stop laxati...
Is this patient abusing laxatives?
YES. But, is it an eating disorder, or is she just
an older adult with constipation?
 ...
References
Copeland PM. Renal failure associated with laxative abuse. Psychother
Psychosom. 1994;62:200-202.
Cummings JH, ...
References
Pronsky ZM, Crowe JP. Food Medication Interactions Seventeenth Edition.
2012. Birchrunville: Food Medication In...
Upcoming SlideShare
Loading in …5
×

Chronic Constipation and Laxative Abuse

1,492 views

Published on

A case study presentation focusing on laxative abuse in older adults

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,492
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
26
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Chronic Constipation and Laxative Abuse

  1. 1. Chronic Constipation and Laxative Abuse LAURA HUTCHINSON DIETETIC INTERN BENEDICTINE UNIVERSITY
  2. 2. Patient Profile  Age: 84  Gender: Female  Race: Caucasian  Height: 4’11  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 constipation/obstipation
  3. 3. Patient Hx  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.
  4. 4. Interrelationships of Medical Dx Hypertension  CKD Stage III   Anemia  Osteoporosis    Increased Age Fluid Restriction Small Stature Mobility  Depression    Chronic Constipation  Laxative Abuse?
  5. 5. Nutrition Diagnoses  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.
  6. 6. 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?
  7. 7. What is Laxative Abuse?  Laxative abuse is the repeated misuse and overuse of laxatives involving      Dosing too frequently Overdosing 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 bowel function (Fruit Eze)
  8. 8. Types of Laxatives  Bulk-Forming Laxatives  Saline Laxatives  Osmotic Laxatives  Surfactant Laxatives   Lubricants  Stimulant Laxatives  Diphenylmethane derivatives  Anthraquinone derivatives (Roerig)
  9. 9. Profile of a Laxative Abuser  Eating Disorder patients      Histrionic personality traits Lower self-esteem Lower “self-liking” Weight and shape concerns Depression  Middle aged or older adults  Perceived poor physical health  Athletes in sports with weight limits  Factitious disorder patients  Comorbidities (Roerig, Steffen, Pryor, Harari, Surgenor, Weltzin)
  10. 10. A Vicious Cycle –with dehydration, the reninangiotensin system kicks in, following by rehydration and water weight gain Complications (Roerig)
  11. 11. Electrolyte Disturbances Metabolic Disturbances Bowel Disturbances  Kidney Disturbances Complications (Roerig, Cummings, Copeland)
  12. 12. Diagnosis  Practitioner’s suspicion  Melanosis Coli  GI symptoms  Serum hypokalemia  Fecal electrolytes  Stool osmotic gap : 290 – 2* (Stool Na + Stool K) (Roerig)
  13. 13. Role of the Registered Dietitian  Identify patient’s bowel patterns.  Identify type and frequency of laxative use.  Be specific – patients will not always willingly offer this information.  Check labs, electrolytes, and fluid status.  Monitor for disordered eating patterns or disordered bowel regimens.
  14. 14. Treatment/Monitoring  Education  Appropriate treatment for eating disorders  Risks?  Goals of treatment:  Stop laxative abuse  Maintain healthy GI Function  Weight trends  Labs and other nutritional parameters
  15. 15. Is this patient abusing laxatives? YES. But, is it an eating disorder, or is she just an older adult with constipation?  Anxiety/depression issues  Rigid bowel regimen  Renal failure  Aging  Poor appetite
  16. 16. References Copeland PM. Renal failure associated with laxative abuse. Psychother Psychosom. 1994;62:200-202. Cummings JH, Sladen GE, James OF et al. Laxative-induced diarrhoea: a continuing clinical problem. BMJ. 1974;23:537-541. Escott-Stump S. Nutrition and Diagnosis Related Care Seventh Edition. 2012. Baltimore: Lippincott, Williams, and Wilkins. Fruit-Eze. Laxative Abuse and the Laxative Habit. 2003. Retrieved on May 7, 2013 from http://web.pdx.edu/~sujata/FruitEzeWeb/education/ laxative/habit.html Harari D, Gurwitz JH, Avor J et al. Constipation: assessment and management in an institutionalized elderly population. J Am Geriatric Soc. 1994;42:947-952. Mahan LK, Escott-Stump S, Raymond J. Krause’s Food and the Nutrition Care Process Thirteenth Edition. 2010. St. Louis: Elsevier Saunders. Mikrut R, Groetsma C et al. Clinical Dietetic Reference Pocket Guide. 2010. Hines: Edward Hines Jr. Hospital Department of Veterans Affairs Pagana KD, Pagana TJ. Mosby’s Diagnostic and Laboratory Test Reference Tenth Edition. 2011. St. Louis: Elsevier Mosby.
  17. 17. References Pronsky ZM, Crowe JP. Food Medication Interactions Seventeenth Edition. 2012. Birchrunville: Food Medication Interactions. Pryor T, Widerman MW, McGilly B. Laxative Abuse Among Women With Eating Disorders: An Indication of Pathophysiology? Int J Eat Disord. 1996;20(1):13-18. Roerig JL, Steffen KJ, Mitchell JE, Zunker C. Laxative Abuse: Epidemiology, Diagnosis, and Management. Drugs. 2010;70(12):1487-1503. Steffen KJ, Mitchell JE, Roerig JL. The eating disorders medicine cabinet revisited: a clinician’s guide to ipecac and laxatives. Int J Eat Disord 2007;40:360-368. Surgenor LJ, Maguire S, Russel J, et al. Self-liking and aself-competence: relationship to symptoms of anorexia nervosa. Eur Eat Disord Rev. 2007;15:139-145. Weltzin TE, Bulik CM, McConaha CW et al. Laxative withdrawal and anxiety in bulimia nervosa. Int J Eat Disord. 1995;17:141-146. Wilson BA, Shannon MT, Shields KM. Pearson Nurse’s Drug Guide. 2013. Upper Saddle River: Pearson Education.

×