Constipation in the elderly is a violation of the stool in patients 60 years of age and older, in which the frequency of bowel movements is less than 3 times a week or bowel movements require additional effort. The symptom is often caused by natural age-related changes in the intestinal wall, but can also be caused by organic diseases of the digestive tract. To determine the causes of constipation, ultrasound, X-ray and endoscopic examination, laboratory tests are performed. To normalize the condition, older people are prescribed herbal decoctions, osmotic laxatives, rectal suppositories.
Causes of constipation in the elderly
Physiological features
According to statistics, about 60% of people after 6 years of age suffer from defecation disorders. Constipation significantly impairs the quality of life and contributes to the occurrence of organic pathologies of the lower gastrointestinal tract. In the vast majority of the elderly, stool retention is due to natural changes in the nervous regulation and age-related dystrophy of the smooth muscles of the digestive tract. The main physiological causes of the violation of the normal frequency of bowel movements:
- Atony of the intestine . Elderly people with a weakened tone of the intestinal wall are characterized by the absence of feces for 3 days or more, not accompanied by other dyspeptic symptoms. Due to disorders of innervation, patients do not feel the urge to defecate. It takes effort to empty the bowels. Often, patients resort to various manipulations - they press their hands on the perineum, spread the buttocks to the sides, which contributes to the release of feces.
- Hypodynamia . Constipation occurs in older people who, for medical reasons, need to adhere to bed rest. As a rule, independent discharge of feces is difficult or impossible. Against the background of a long delay in fecal masses, bloating or pain in the left iliac region is noted. Defecation often occurs only after a cleansing enema, oil microclysters or laxatives.
- Weakness of the abdominal muscles . Normal emptying is disturbed due to dystrophic and degenerative changes in the muscles of the abdominal wall. The urge is felt, but the passage of feces is difficult. In severe cases, patients are forced to resort to manual assistance. When defecation, you have to strain, excessive tension can be accompanied by a sharp pain in the anus.
- Diet features . Older people experience problems with emptying after taking a large amount of pastries, milk porridges, white bread. Usually, feces are absent for 2-3 days, after which defecation occurs independently with the release of dry feces in the form of lumps. Stool retention can also be caused by drinking several cups of strong tea a day, overeating.
- Disorders of the endocrine system . In the elderly, a special category of disorders is distinguished - endocrine constipation associated with age-related hypofunction of the thyroid, parathyroid and gonads. Self-emptying is extremely rare (1-2 times a week), patients complain of heaviness and discomfort on the left in the iliac region. During defecation, solid lumps of feces are released, which injure the mucous membrane of the rectum.
- stressful situations. Due to disruption of the coordinated work of different brain structures and the autonomic nervous system, constipation in the elderly becomes a reaction to strong emotional upheavals. Many patients complain of fecal retention after a change in their usual living conditions: moving, hospitalization. These disorders are short-lived and respond well to non-pharmacological treatment.
Proctological diseases
Various pathologies of the rectum are accompanied by constipation, which is caused not only by mechanical obstacles to the movement of feces, but also by reflex spasm of the sphincter in response to pain. Because of the fear of pain when emptying, many older people hold back the urge, which further aggravates the situation. In case of proctological diseases, stool retention can be combined with the release of mucus and blood from the rectum both during the act of defecation and during the day. Constipation is most often caused by:
- Hemorrhoids . Patients experience difficulty with bowel movements, there may be a subjective feeling of incomplete emptying of the intestine. Sometimes, with strong straining, patients notice the loss of red-cyanotic formations from the anus (varicose veins). Over time, constipation becomes chronic, stools are absent for 7 days or longer. Defecation is accompanied by intense pain.
- Proctitis . Violation of defecation is characterized by short-term constipation, after which there is always an independent excretion of feces, requiring increased effort. When stool is released, older people note an increase in pain. Depending on the degree of inflammation, fecal retention may alternate with frequent false urges to defecate, in which mucus and blood are separated.
- Polyps of the rectum . Constipation in tumor formations is associated with partial intestinal obstruction. Typically a gradual decrease in the frequency of bowel movements. Feces are excreted in small lumps, with a pronounced narrowing of the intestinal lumen, “pencil” or ribbon-like feces are formed. A similar variant of constipation occurs in the elderly in the case of acquired rectal diverticula.
Bowel disease
Constipation in elderly patients may be associated with organic lesions of the intestinal wall, which contribute to the retention of feces in the intestines, its compaction and difficulty in excretion. Colonic pathology develops primarily or as a complication of other gastroenterological diseases. If the violations are caused by a lesion of the colon, they are complemented by diffuse pain in the abdomen, worsening of the general condition. Constipation is caused by:
- Chronic colitis . Inflammation of the large intestine is characterized by retention of feces in combination with periodic release of blood and mucus from the anus. The frequency of bowel movements decreases, when emptying, you have to make additional efforts, strain the abdominal muscles. Constipation associated with painful, ineffectual urges. Delayed stool increases pain, so patients begin to take laxatives on their own.
- Acquired megacolon . Older people complain of chronic constipation, the duration of which reaches a week or more. The urge to stool is practically absent. During independent or due to the intake of laxatives, defecation is disturbed by severe pain in the anus, associated with the release of large hard lumps of feces. The disorder is always accompanied by severe flatulence.
- Pneumatosis of the intestine . For pathology, prolonged constipation with bloating and paroxysmal pain is typical. The absence of feces for 4-5 days is replaced by watery diarrhea with a lot of mucus. Pneumatosis is characterized by periodic retention of feces, the severity of which correlates with the degree of morphological changes. Stool retention is not associated with errors in the diet.
- Adhesive disease . In elderly patients, constipation can be caused by squeezing a section of the intestine with connective tissue bridges. The duration of stool retention ranges from a few days to a week or more. In the case of self-emptying, a small amount of dry feces is excreted. The bowel movement is accompanied by pain in the anus due to trauma to the mucosa.
Tumors
Malignant neoplasms of the large intestine are a common cause of constipation in the elderly, since they develop mainly after 55-6 years. Patients are concerned about chronic stool retention, which is not eliminated even after the use of laxatives. Defecation is difficult, for emptying it is necessary to strain strongly. The excretion of feces is accompanied by severe pain in the anal area, sometimes patients notice impurities of dark blood in the feces. General changes are increasing: loss of appetite, weight loss.
Intestinal obstruction
Absence of fecal masses with sharp pains in the abdomen and repeated vomiting is a characteristic sign of acute intestinal obstruction. Both a mechanical form of the disease (with obstruction of the intestinal lumen by a tumor, fecal stone, with infringement of a hernia along with an intestinal loop or mesentery) and a dynamic form of intestinal paresis are possible. Normally, in the elderly, stools can be delayed for 2-3 days, therefore, with chronic intestinal obstruction, patients pay attention to the presence of problems with the gastrointestinal tract only if there is no bowel movement for 5 or more days.
Complications of pharmacotherapy
Fecal retention is an adverse reaction to many drugs used to treat hypertension, anemic conditions, emotional and cognitive disorders, and other chronic diseases in the elderly. Medication constipation most often develops with the abuse of secretory laxatives and the systematic use of pharmaceuticals of the following groups:
- Calcium antagonists : verapamil, finoptin, nifedipine, corinfar.
- β-blockers : atenolol, bisoprolol, corvitol.
- Cholinolytics : atropine, pachycarpine, cyclodol.
- Diuretics : furosemide, hypothiazide.
- Non-steroidal anti-inflammatory drugs : aspirin, ibuprofen, indomethacin, naproxen.
- Narcotic analgesics : morphine, codeine, their derivatives.
- Antidepressants : nialamide, tranylcypromine, pyrazidol, befol.
- Antipsychotics of the phenothiazine series : chlorpromazine, thioridazine, pipothiazine.
- Barbiturates : barboval, corvaldin, corvalol, reladorm.
- Antiepileptic drugs : difenin.
- Antianemic drugs with iron : sulfate, fumarate, ferrous gluconate.
- Antacids : aluminum hydroxide, calcium carbonate.
- Antidiarrheals : fthalazole, activated charcoal, loperamide.
Survey
A gastroenterologist is engaged in finding out the causes of constipation in the elderly. Diagnostic search involves a comprehensive examination of the gastrointestinal tract, which is aimed at studying the morphological features and functionality of the digestive system. If necessary, appoint consultations of other specialists. The most informative are:
- Rectal examination . A digital examination of the rectum is performed to study the structure of the mucous membrane, determine enlarged hemorrhoids, cracks and volumetric formations. According to indications, the examination is supplemented with anoscopy or sigmoidoscopy to visualize the lower sections of the large intestine.
- Endoscopy . Colonoscopy is prescribed for all elderly people with complaints of delayed defecation for a detailed study of the structure of the colon and sigmoid colon, and detection of tumor neoplasms. If suspicious areas are found, a biopsy is performed for further histological analysis.
- X-ray examination . Performing x-rays after oral contrasting of the gastrointestinal tract with barium sulfate is necessary to detect organic changes in the intestinal wall, signs of ulcerative defects, and inflammatory processes. Delayed imaging is done to determine the rate of passage of chyme through the intestines.
- Sonography. With the help of ultrasound of the abdominal cavity, the structural and functional features of the digestive tract are evaluated, pathological changes that can provoke constipation are revealed. If necessary, ultrasound of the large vessels of the abdominal cavity is performed to exclude occlusion of the mesenteric arteries.
- Fecal analyzes . Constipation in the elderly is accompanied by a change in the consistency and composition of feces, which is established using a coprogram. To study the microflora of the large intestine, bacteriological analysis is carried out. The Gregersen reaction to occult blood helps to exclude chronic bleeding from the gastrointestinal tract.
To clarify the diagnosis and detailed visualization of the structures of the abdominal cavity, computed tomography is prescribed. All patients undergo general and biochemical blood tests. If a lesion of the intestinal vasculature is suspected, contrast-enhanced angiography is performed. To exclude diseases of the hepatobiliary system, duodenal sounding with microscopic and bacteriological examination of bile is used.
If you are prone to constipation, you should reconsider the diet
Symptomatic therapy
If constipation is associated with age-related changes in the body, non-drug methods are primarily used to normalize the stool. It is recommended to include fiber-rich foods in the diet: whole grain bread, fresh or stewed vegetables. To restore natural bowel movements, it is helpful to drink about 2 liters of fluid per day. It is better to replace tea with sour-milk drinks, compotes. To stimulate peristalsis, older people need to eat a piece of bread with butter in the morning or drink 1 tablespoon of vegetable oil.
To strengthen the abdominal muscles and accelerate the movement of feces, it is recommended to perform a special set of physical exercises. To eliminate constipation, you can use herbal preparations - decoctions of buckthorn bark, yarrow herbs. In order to quickly cleanse the intestines, enemas are prescribed. For persistent constipation, oral laxatives, rectal suppositories are used. If the stool is delayed for more than 3 days, which is accompanied by intense pain in the abdominal cavity, a violation of the general condition, it is necessary to consult a doctor as soon as possible.