common causes of constipation in adults
- > 65 y/o
- Diet (↓ fiber)
- Medications
- Metabolic/neurologic disorders
- Psychosocial issues
- Pregnancy
expected frequency of bowel movements in an adult
< 3 unassisted BM per week = abnormal
current therapies used to manage constipation in adults
- lifestyle modification
- increase fiber and fluid, decrease red meat and dairy - medications
- change medications possibly causing sxs
- prescribe medications to help with symptoms (stool softener/laxative)
Opioid induced constipaiton
- Opioids interfere w/normal GI motility by delaying transit (↑ contact time for absorption of fluids), stimulate non-propulsive motility, & stimulate sphincters (i.e. pylorus & ileocecal) through effects on enteric neurons
- Act on μ-receptors in GI tract
Rationale for using fiber supplementation in the management of constipation
fiber is neither digested or absorbed—will ↑ stool volume and weight; ↓ stool transit time
Correlate exercise frequency to bowel function.
↑ exercise causes ↑ bowel function
Osteopathic structural examination findings in constipation
TART changes in T12-L2 paraspinal region
Rationale for the use of OMT in patients with constipation
Treat viscerosomatic reflex associated with constipation
Define lactose intolerance
clinical syndrome characterized by GI symptoms following lactose ingestion as a result of lactose malabsorption (↓ hydrolysis & digestion of lactose d/t lactase deficiency)
physiological basis for lactose intolerance
-lactase is not present/not functioning properly so lactose is not able to be broken down
Relate sxs of lactose intolerance to physiology
- Malabsorbed lactose generates osmotic load & draws fluid & electrolytes into intestinal lumen causing watery/lose stool
- Colonic bacteria ferments the unabsorbed lactose causing gas(methane, CO2, & hydrogen), abdominal pain, bloating
How to increase calcium intake in patients with lactose intolerance
Calcium rich diet—leafy greens, oranges, calcium fortified juices, cereals, breads, etc., legumes + supplements
Lactose Tolerance Test
Measures blood glucose 2 hrs after ingesting high levels of lactose—no/little rise in BG suggests person lacks lactase—not hydrolyzing lactose to glucose
Hydrogen Breath Test
- Measures H in breath after ingesting large amount of lactose—should be very little H+, if H+ rises then indicative of lactose fermenting in intestine
- After 60 min. if H+ is < 20 ppm = diagnostic criteria for lactose intolerance
Types of Lactose Intolerance
- Primary: deficiency/ absence of lactase—most common to develop in childhood
- Secondary: lactase deficiency caused by injury/damage to small intestine—transient
- Congenital: absolute absence of lactase present from birth—Rare
coenzyme
organic-vitamin
cofactor
inorganic
