ROSH Gastrointestinal Practice Exam

What is the most appropriate initial management for a 60-year-old woman experiencing chronic constipation?

1. Fecal disimpaction

2. Fiber restricted diet

3. Increased fiber intake

4. Suppository use as needed

The correct answer is: Increased fiber intake

The most appropriate initial management for a 60-year-old woman experiencing chronic constipation is increased fiber intake. Fiber plays a crucial role in gastrointestinal health by adding bulk to the stool and promoting regular bowel movements. A diet rich in fiber can help soften the stool and facilitate its passage through the intestines. For someone experiencing chronic constipation, the introduction of fiber should be gradual in order to prevent cramping, and patients are often encouraged to consume a variety of fiber sources, including fruits, vegetables, whole grains, and legumes. Additionally, ensuring adequate fluid intake along with increased fiber is essential, as fluids help fiber work more effectively in the digestive system. Other strategies, such as fecal disimpaction, may be appropriate in more severe cases, but they are not the first line of management for chronic constipation that is not obstructive in nature. A fiber-restricted diet would be contraindicated, as it would likely worsen constipation symptoms by reducing stool bulk. Suppository use could provide temporary relief but does not address the underlying issue and is typically not recommended as a first-line approach for chronic constipation. Emphasizing increased fiber intake fosters long-term bowel health and encourages patients to adopt dietary habits that can prevent future episodes of constipation.