GASTROINTESTINAL DRUGS

Brief History. M.B. is a 48-year-old insurance sales representative with a long history of back pain. He has had recurrent episodes of sciatica because of a herniated disk at the L5-S1 interspace. He frequently takes a nonprescription form of ibuprofen at 400 mg/dose to help alleviate his back pain. M.B. has a rather sedentary lifestyle and often eats poorly by consuming a high-fat, low-fi ber diet. He frequently suffers from acid indigestion and often takes a nonprescription antacid preparation (Mylanta suspension) that contains magnesium hydroxide, aluminum hydroxide, and simethicone. Currently, he is being seen as an outpatient in a private physical therapy practice. Despite several treatments, his back pain has not improved. In fact, his pain was recently exacerbated when he was straining to pass a stool during a period of constipation. Evidently, the straining occurred often during defecation, and the patient’s back problems were increased by the bowel-related problems that caused the straining.

1. How is M.B.’s current behavior contributing to his constipation?

2. What advice should the therapist provide to reduce the chance of constipation and exacerbation of back pain?