Answer to Question 1
In individuals with a low fiber intake, the primary treatment for constipation is a gradual increase in fiber intake to at least 20-25 grams per day. High-fiber diets increase stool weight and fecal water content and promote a more rapid transit of materials through the colon. The transition to a high-fiber diet may be difficult for some people because it can increase intestinal gas, so high-fiber foods should be added gradually, as tolerated. Fiber supplements such as methylcellulose (Citrucel), psyllium (Metamucil, Fiberall), and polycarbophil (Fiber-Lax) are also effective; these supplements can be mixed with beverages and taken several times daily. Unlike other fibers, methylcellulose and polycarbophil do not increase intestinal gas. Consuming adequate fluid enhances the effect of an increased fiber intake on stool frequency, and an appropriate fluid intake prevents excessive reabsorption of water from the colon, resulting in wetter stools. Consuming prunes or prune juice is often recommended because prunes contain compounds that have a mild laxative effect. Skipping breakfast is discouraged, as colonic motility is highest after a morning meal. Inactive individuals are generally encouraged to increase physical activity, although clinical studies have not confirmed that increasing exercise improves constipation symptoms.
Answer to Question 2
D
Patient receiving ultrasound treatment to the left elbow.
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The DASH diet, rich in whole grains, fruits, vegetables, and low-fat dairy foods