Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 512

The evaluation of constipation begins with understanding the patient’s perspective on their altered bowel function and the time course of constipation development. The acute or subacute onset of constipation requires a more aggressive diagnostic approach to exclude structural lesions, including colon neoplasia, stricture, and volvulus. Likewise, weight loss, rectal bleeding, history of inflammatory bowel disease, family history of colorectal neoplasia, or iron deficiency anaemia requires a structural examination to exclude cancer or other aetiology. Additional helpful details in the patient history include the onset of constipation, frequency of bowel movements, sensation of incomplete evacuation, straining to defecate, consistency of the stool, associated abdominal pain, the need for digitation, perineal splinting or unusual postures for defecation to occur, episodes of bowel incontinence, prior abdominal or pelvic surgery, prior abdominal or pelvic radiation therapy, and prior pregnancies. It is also necessary to review current medications and supplements, current and previously used laxatives with their degree of effectiveness, use of enemas, and use of complementary therapies to treat constipation (e.g. high colonics, herbs, teas). Dietary history includes a general survey of calories ingested, fibre intake, and restricted foods. Given the consistent association of constipation with depression and anxiety, a brief psychological assessment is also warranted. In general, the ideal, evidence‐based approach to the diagnostic evaluation of constipation remains to be identified.