Altered bowel or bladder activity in the elderly

Chapter 33 Altered bowel or bladder activity in the elderly



Case 33.1


Bob is a 75-year-old who complains about a recent change in bowel habits. For as long as he can remember, he used to defecate once each day. However, over the last 6 months, this has gradually changed so that he now defecates on average once every 2 days. He has no abdominal pain, nausea, vomiting or episodes of diarrhoea, nor has he noticed any blood within or upon his stools. He states that his appetite is fine, but admits to having lost 2–3 kg over this period of time.




Questions



1. What are the possible causes of constipation commencing in a man of this age?

2. What specific questions do you need to ask?

3. On examination, you find no abnormalities, although you have not done a rectal examination. What will you do now? Why?

4. If Bob was to be investigated for this problem, what do you think would be included in the first round of tests? Why?


Case 33.2


Rosy is a 79-year-old woman who presents with a bowel problem. She has had a problem with constipation for many years, but has now noticed that over the last 9–12 months she occasionally has bouts of diarrhoea. She states that it is not a huge amount, but is quite loose and watery. She has not noticed any blood in her stools at any time. Her appetite is good, and she has lost no weight.




Questions



1. With this information only, what are the possible causes of her symptoms?

2. What questions do you need to ask?

3. On examination, you find no abnormalities, although you have not done a rectal examination. What will you do now? Why?

4. If she was to be investigated for this problem, what do you think would be included in the first round of tests? Why?


Case 33.3



History


Rita is a 72-year-old patient currently undergoing rehabilitation for a recent knee injury. She reports that she has been having a problem with her bowels, characterised by a gradual worsening of constipation over the last 6 months. She admits that she often had this type of problem in the past, even as a much younger woman, but that this is worse than normal.


Further questioning reveals that she has also noticed a little blood on the surface of her stools. She says that this is probably just her haemorrhoids ‘playing up’, although they have never bled before. Her appetite is reduced, she feels more tired than usual, and states that she is just ‘not herself’.


There have been no episodes of diarrhoea, abdominal pain or vomiting over the last 2 years.


She is a non-smoker, a social drinker, and her only medication is Actonel (risedronate sodium).



Questions



1. Using only this information, list the possible causes of Rita’s:
a constipation

b rectal bleeding

c anorexia, fatigue and general feeling of unwellness.

2. What extra questions do you need to ask?

3. What type of drug is Actonel? What is it used for?

4. What do you need to examine in this patient?

5. Do you think that all her symptoms could be related to the same pathology? At this point, what are you thinking?


Physical examination














































General Rita is alert and well-oriented, although appears concerned about her health
Vitals •Pulse rate/min 86, regular
•Respiratory rate/min 14
•Blood pressure mm Hg 130/90
•Temperature (degrees C) 37
HEENT No jaundice, but pallor of conjunctiva is noted
Chest Heart sounds are normal: no murmurs
Chest clear
No breast masses
Abdomen Abdomen is distended but non-tender
Sign of shifting dullness is present
Liver is not easily palpable
Rectal examination not performed
Limbs Palmar erythema and clubbing noted on hands
Neurological Normal


Questions



6. Explain the significance of each of the following investigation results:
a a sign of ‘shifting dullness’

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Altered bowel or bladder activity in the elderly

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