ROSH Gastrointestinal Practice Exam

For a 70-year-old woman with difficulty having bowel movements, what is the most appropriate initial therapy?

1. Docusate sodium

2. Methylcellulose

3. Polyethylene glycol

4. Senna

The correct answer is: Methylcellulose

In the case of a 70-year-old woman experiencing difficulty having bowel movements, the most appropriate initial therapy is methylcellulose. Methylcellulose is a bulk-forming laxative that works by absorbing water in the intestines, which helps to increase stool bulk and promotes regular bowel movements. This approach is generally considered safe and suitable for older adults, as it mimics the body's natural processes without causing harsh stimulation of the bowel. Bulk-forming agents like methylcellulose are often recommended as first-line treatment for constipation, especially in the elderly, because they have a low risk of side effects and can help improve bowel function gradually. Adequate hydration with these agents is also important, as they require sufficient fluid to work effectively. While other options such as docusate sodium (a stool softener), polyethylene glycol (an osmotic laxative), and senna (a stimulant laxative) may also be used in treating constipation, they are generally not the first choice in this demographic. Bulk-formers are typically favored for their gentle approach and beneficial effects on overall bowel health.