Constipation in the elderly

Constipation in the elderly - stool delay more than 48 hours with no satisfaction from the act of defecation, a small amount of cap (less than 30.0 per 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 colon abnormalities;
7. medication;
8. endocrine;
9. with violations of water and electrolyte metabolism.

[1], [2], [3], [4], [5]

What causes constipation in older people?

Drug-induced constipation in the elderly occurs with the use of ganglioblokatorov, anticholinergics, sedatives and tranquilizers, antacids and diuretic, laxatives (long) and fixatives.

Diarrhea and constipation in older people can be a sign of various organic diseases or be functional. Functionally caused diarrhea in elderly and senile persons is relatively rare, as an exception to the rule.

Constipation in elderly without organic causes is often observed. It is more often observed in older women. Functionally caused constipation often occurs when a combination of several factors: food consumption, poor plant fiber, limiting physical activity, weakening the tone of the muscles of the pelvic floor and abdominal wall, falling contractile ability of the diaphragm, reducing intra-abdominal pressure and muscle tone of the large intestine (atonic constipation) or increasing the tone colon (spastic constipation). Alimentary constipation: occurs with prolonged use of low-slag refined food. Milk is often indicated as a product. Mechanical constipation develops in patients with intestinal tumors, with narrowing of the large intestine of cicatricial genesis, mechanical pressure from the outside, etc.

Constipation in the elderly due to colon abnormalities occurs in individuals with congenital megacolon. At the same time, the evacuation function of the colon is disturbed from early adolescence, and with age other causes of constipation always join, and there is usually no independent stool.

Endocrine constipation in older people occurs with myxedema, hyperparathyroidism, pituitary disorders, diabetes, menopause, pheochromocytoma, and other diseases.

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

Hypodynamic constipation in the elderly is found in patients with prolonged bed rest. In gerontological practice, it can be chronic. Sometimes a decrease in intestinal motility and a violation of the act of defecation due to insufficient physical activity of patients and weakness of their muscles.

Neurogenic constipation in older people is quite common. It occurs in connection with disorders of the nervous mechanisms of the regulation of intestinal motility at any level of the nervous system. A very common type of neurogenic constipation is dyskinetic. The 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 persistent hard stools.

Most patients older than 60 years old constipation occur due to the effects of several reasons, therefore, are persistent and stubborn nature.

Elderly and senile people with constipation may experience fecal incontinence, mechanical obstruction of the intestines, urinary retention, rectal bleeding.

Treatment of constipation in the elderly

Valid individual diet. In the diet is injected: sour-milk products, fresh sour cream, vegetable oil, crumbly cereal from buckwheat and millet groats, wheat bread with the addition of bran, carrots and beets in the wiped form (both raw and boiled), decoction of prunes and other dried fruits. Fermentation products are excluded: legumes, apples and grape juices, vegetables rich in essential oils (radishes, garlic, radishes, onions), whole milk. It shows the use of mineral water (Essentuki number 4 and number 19, Slavyanovskaya, Nurly, Jermuk, etc.) in the cold form of 1 cup for 1 hour before meals 2-3 times a day. In the case of increased motor function of the intestine, mineral waters are used in the form of heat. Measures aimed at restoring the normal reflex to defecation: the creation of the usual conditions for the patient and the time of bowel movements.

Therapeutic effects on colon dyskinesia:

• in hypomotor dyskinesia, agents that stimulate intestinal peristalsis (metolopradmid, propulside 10 mg daily for 2–3 weeks);
• in spastic dyskinesia, M-anticholinergics (gastropin, metacin) myotropic antispasmodics (no-spa, papaverine);
• the use of drugs that normalize the intestinal microflora, bifidumbacterin, bifikol bactisubtil, lactobacterin.

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

1. agents that cause chemical irritation of the intestinal receptor apparatus: senna, buckthorn, rhubarb, gunulx, phenolphthalein, castor oil;
2. means inhibiting the absorption of water: sodium sulfate, magnesium sulfate, salt Karlovy Vary, portopak, normase;
3. means of increasing the volume of the contents of the intestine: bran, agar, methyl cellulose, seaweed;
4. the means promoting softening of the fecal masses and their sliding: vaseline and almond oils, liquid paraffin, contact means (glycerin, “effervescent candles”).

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

Considering contraindications, it is possible to use physiotherapeutic procedures: ultraviolet irradiation, electrophoresis (with hypermotor dyskinesia — with magnesium or antispasmodics, with hypomotor dyskinesia — with calcium), mud applications, etc. To treat the problem of constipation, the patient has to have therapeutic effects that eliminate the causes of intestinal impairment disorders.