Constipation in the elderly

Constipation in the elderly - delay in stool for more than 48 hours with lack of satisfaction from the act of defecation, small amount of stool (less than 30.0 in 72 hours).

In elderly patients, the following groups of constipation can be distinguished:

1. alimentary;
2. neurogenic;
3. hypodynamic;
4. proctogenic;
5. mechanical;
6. due to developmental abnormalities of the large intestine;
7. medicinal;
8. endocrine;
9. in case of water-electrolyte balance disorders.

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What causes constipation in older adults?

Drug-induced constipation in the elderly occurs with the use of ganglionic blockers, anticholinergics, sedatives and tranquilizers, antacids and diuretics, laxatives (long-term) and constipating agents.

Diarrhea and constipation in the elderly may be a sign of various organic diseases or be functional in nature. Functionally conditioned diarrhea in the elderly and senile is relatively rare, an exception to the rule.

Constipation in the elderly without organic causes is often observed. It is more often observed in elderly women. Functionally conditioned constipation often occurs with a combination of several factors: consumption of food poor in plant fiber, limitation of physical activity, weakening of the muscle tone of the pelvic floor and abdominal wall, a decrease in the contractility of the diaphragm, a decrease in intra-abdominal pressure and muscle tone of the colon (atonic constipation) or an increase in the tone of the colon (spastic constipation). Alimentary constipation: occurs with prolonged intake of low-slag refined food. Milk is often indicated as a product. Mechanical constipation develops in patients with intestinal tumors, with narrowing of the colon of cicatricial genesis, mechanical compression from the outside, etc.

Constipation in the elderly due to anomalies in the development of the colon occurs in people with congenital "megacolon". In this case, the evacuation function of the colon is impaired from early youth, and with age, other causes of constipation always join in, and independent stool usually does not occur.

Endocrine constipation in the elderly is observed with myxedema, hyperparathyroidism, pituitary disorders, diabetes mellitus, menopause, pheochromocytoma and other diseases.

Constipation in the elderly due to water-electrolyte metabolism disorders. In elderly and old people, this is observed in the presence of cardiac and renal failure with edema, ascites, cholestasis, and insufficient fluid intake.

Hypodynamic constipation in the elderly occurs in patients who have been on bed rest for a long time. In gerontological practice, it can be chronic. Sometimes, decreased intestinal motility and impaired bowel movements are caused by insufficient physical activity of patients and weakness of their muscles.

Neurogenic constipation is quite common in the elderly. It occurs due to disturbances in the nervous mechanisms regulating intestinal motility at any level of the nervous system. A very common type of neurogenic constipation is dyskinetic. Accumulation of feces in the sigmoid colon causes a feeling of pressure and pain in the left iliac region.

Proctogenic constipation in older people occurs with tumors in the rectum, hemorrhoids, anal fissures, which, in turn, are often the cause of constantly hard stool.

In most patients over 60 years of age, constipation occurs due to several causes, and is therefore persistent and persistent.

In elderly and senile people, constipation may cause fecal incontinence, mechanical intestinal obstruction, urinary retention, and rectal bleeding.

Treatment of constipation in the elderly

A justified individual diet. The diet includes: fermented milk products, fresh sour cream, vegetable oil, crumbly porridge made from buckwheat and millet, wheat bread with added bran, mashed carrots and beets (both raw and cooked), a decoction of prunes and other dried fruits. Excluded are products that cause fermentation: legumes, apples and grape juice, vegetables rich in essential oils (radishes, garlic, horseradish, onions), whole milk. It is recommended to use mineral water (Essentuki No. 4 and No. 19, Slavyanovskaya, Nurly, Jermuk, etc.) cold, 1 glass 1 hour before meals 2-3 times a day. In case of increased intestinal motility, mineral waters are used warm. Measures aimed at restoring the normal defecation reflex: creating conditions and times for bowel movements that are familiar to the patient.

Therapeutic effects on colonic dyskinesia:

• for hypomotor dyskinesia - drugs that stimulate intestinal peristalsis (metolopradmid, propulsid 10 mg daily for 2-3 weeks);
• for spastic dyskinesia M-anticholinergics (gastrocepin, metacin) myotropic antispasmodics (no-shpa, papaverine);
• use of drugs that normalize intestinal microflora, bifidumbacterin, bificol baktisubtil, lactobacterin.

Strict indications for the use of laxatives (in the short term) and enemas. According to the mechanism of action, laxatives for constipation for the elderly are divided into:

1. agents that cause chemical irritation of the intestinal receptor apparatus: senna, buckthorn, rhubarb, guttallax, phenolphthalein, castor oil;
2. agents that inhibit water absorption: sodium sulfate, magnesium sulfate, Carlsbad salt, Portopac, Normase;
3. agents that increase the volume of intestinal contents: bran, agar, methyl cellulose, kelp;
4. agents that help soften stool and make it glide: vaseline and almond oils, liquid paraffin, contact agents (glycerin, effervescent suppositories).

General recommendations for the elderly: a regime of sufficient physical activity, regular breathing exercises, training of the muscles of the anterior abdominal wall and pelvic floor.

Taking into account contraindications, it is possible to use physiotherapeutic procedures: UV irradiation, electrophoresis (with magnesium or antispasmodics for hypermotor dyskinesia, with calcium for hypomotor dyskinesia), mud applications, etc. To solve the problem of constipation in a patient, therapeutic interventions are required to eliminate the causes of bowel movement disorders.