Why Should Constipation Be Prioritized

The elderly are five times more probable than younger adults to develop problems related to constipation.

Causes of constipation in the elderly

Some of the reasons for this propensity include poor diet, lack of adequate fluids in nutrition, lack of practise, the use of sure drugs to treat other medical conditions, and poor bowel habits.

In add-on there is a psychological angle and many older adults are excessively concerned most their bowel movements and constipation is ofttimes an imaginary ailment.

There is often a lack of involvement in eating that is seen in single or widowed older people. This leads to over use of convenience foods, which tend to exist low in fiber.

Loss of teeth may farther make eating regular meals difficult. Many older adults thus choose soft, processed foods that are low in fiber.

Many older adults suffer from urinary incontinence and stress incontinence. They may take inadequate fluids in order to avoid urinating. The fluids are also deficient in nutrition if the elderly are non eating regular or balanced meals. H2o and other fluids add together bulk to stools relieving constipation and making stools soft.

Another major cause for constipation in the elderly is prolonged bed rest or being bed ridden for example, afterward an accident or during an affliction. Lack of motility and practice may contribute to constipation.

Drugs prescribed for several medical conditions may lead to constipation amongst the elderly. Some of these include antidepressants, antacids containing aluminum or calcium, antihistamines, diuretics, and anti-Parkinsonism drugs.

Fearing constipation is common among the elderly and this sometimes leads older people to depend heavily on stimulant laxatives. These are habit forming and the bowel movements begin to depend on laxatives and over time, the natural mechanisms fail to piece of work without the help of drugs. Habitual use of enemas also tin lead to a loss of normal bowel movements.

Types of constipation among elderly

Normal transit constipation

This is the about common subtype of chief constipation. Here, despite the stool passing through the colon at a normal rate, patients perceive difficulty in evacuating their bowels. This is normally seen along with irritable bowel syndrome with constipation. The master distinction between chronic constipation and Irritable bowel syndrome (IBS) is the abdominal pain or discomfort seen in IBS.

Slow-transit constipation

This condition is seen more commonly amidst women. There are exceptional bowel movements, limited urgency, or straining to defecate. The colonic movements are slow.

Pelvic floor dysfunction

At that place is a problem in the muscles of the pelvic floor or around the anus (anal sphincter). These patients have a poor ability to co-ordinate these muscles during defecation. At that place is a feeling of incomplete evacuation. There is an overlap of this status with slow transit colon.

Diagnosis of constipation in elderly

Diagnosis begins with detailed history and concrete examination. Drug induced constipation, constipation due to prolonged inactivity and changes in diet and fluid intake may be diagnosed from history.

New onset constipation, worsening of constipation, blood in the stools, unexplained weight loss, fever, nausea, vomiting, loss of appetite, family history of inflammatory bowel disease or colon cancer in older adults over the age of fifty years need to be evaluated advisedly for other conditions underlying constipation including colon and rectal cancers.

A general test is next undertaken to evaluate the presence of other causes of constipation. Other causes that may affect other body systems and manifest as constipation include:

centre diseases like heart failure
Diabetes mellitus
hypothyroidism (underactive thyroid)
hypercalcaemia (increased blood calcium)
hypokalaemia (low blood potassium)
hypermagnesaemia (increased claret magnesium)
hyperparathyroidism (overactive parathyroid glands) etc.

Some musculus and nerve disorders that may crusade constipation include dermatomyositis, systemic sclerosis, autonomic neuropathy, Parkinson'due south illness, spinal cord lesion (tumours or injury) and presence of dementia and depression.

Some diseases of the gastrointestinal system may as well pb to constipation. These include anal crevice, diverticular disease, strictures, irritable bowel disease, rectal prolapsed, volvulus, megacolon etc.

The stool consistency and blazon is noted and classified according to the Bristol stool nautical chart. This helps make up one's mind the colonic transit time. Type 1 stool in the takes about 100 hours (ho-hum transit) while Type 7 takes approximately 10 hours (rapid transit).

Investigations for diagnosis of underlying weather include full blood count to exclude anaemia and thyroid function exam to exclude hypothyroidism.

Bristol Stool Chart

Imaging studies are used to dominion out obstacle leading to constipation. Some of the imaging studies include air dissimilarity barium enema that tin aid notice an obstructing colon cancer, intermittent volvulus, or colonic stricture.

Dynamic pelvic magnetic resonance imaging (MRI) helps in assessment of the beefcake during defaecation and therefore may identify pelvic floor dysfunction.

Other tests include Lower Gastrointestinal (GI)endoscopy, anorectal manometry, electromyography and defaecography.

Management of constipation in elderly

The aims of management of chronic constipation in the elderly are to restore normal bowel habits and ensure passage of soft, formed stool at least three times a week, without straining, and to ameliorate the quality of life with minimal side effects.

Lifestyle changes include increased concrete action, eating a salubrious and balanced nutrition with adequate fibers and fluids. In that location should be reduction in consumption of coffee, tea and alcohol as much every bit possible, and patients should consume extra glass of water for every drink of coffee, tea or alcohol.

Bowel training is also an important measure out. The optimal times to take a bowel movement are presently after waking and soon after meals, when colonic transit is greatest. Patients are taught to recognize and promptly respond to the urge to pass stools. Failure to do so tin result in a build up of stools and constipation. Patients are advised to adopt a "semisquatting" position to defecate. This could be achieved by using a footstool and leaning forward on the toilet.

Apart from fibers in foods patients are advised to take fibre/bulk supplements Psyllium (ispaghula husk), methylcellulose, polycarbophil, or bran.

Medications include osmotic laxatives, stimulant laxatives, and other agents. Bulk laxatives include Psyllium (ispaghula husk), methylcellulose, polycarbophil, bran.

Osmotic laxatives include lactulose, sorbitol, mannitol, salts of magnesia, sulphate, phosphate, polyethylene glycol.

Stimulant laxatives include Senna, cascara and Diphenlmethane derivatives include bisacodyl.

At that place are enemas, liquid paraffin, phosphates, lubricants for fecal impaction as well.

Other options include sacral nerve stimulation, biofeedback system and surgery for refractory and severe cases.