Constipation in the elderly

Constipation in the elderly

Constipation is a symptom of defecation less than usual or unable to defecate for a long time. The behavior and frequency of normal defecation of each person may be different. But in medical practice, this means less than three defecations per week.

Symptoms of constipation
In general, some examples of symptoms of constipation include:

  • Feeling unable to defecate.
  • Difficulty defecating, Must use a lot of force or use your hands to help. There may also be pain during defecation.
  • Bloating, abdominal pain, or abdominal pain
  • Defecate less than 3 times a week or less than usual
  • The stool looks like a hard lump in small granules.

For people who experience a few of the above symptoms for a period of 3 consecutive months, common symptoms of constipation, also known as sudden constipation, may develop into more severe chronic constipation.

Therefore, if an abnormality is found in the defecation change from the original without looking for the cause. Even trying to change the diet and lifestyle habits but the symptoms did not improve or have other symptoms, such as fatigue, fatigue, weight loss, blood transfusion, should see a doctor find the cause that may hide the disorder.

Causes of Constipation
Constipation is a common symptom when the bowel is squeezing or slowing down during digestion. Making it impossible to remove feces from the digestive tract normally. Therefore, the residue in the colon for a long time until the water in the feces is absorbed back. The stool is dry, hard, and larger. Making it difficult to take out. The factors that can cause constipation can come for many reasons, such as:

Drug use
Taking certain medications may cause constipation side effects, such as antacids containing aluminum hydroxide. Antidepressants, Antipsychotic drugs, Seizure medication, Calcium and iron supplements, Opioid analgesics, diuretics, etc.

Physical conditions that affect hormones
Hormones help balance fluids and functions within the body. Therefore, the occurrence of certain gastrointestinal diseases or conditions that cause hormonal abnormalities to occur. Which may cause hormones to lose the balance of work can lead to constipation, Such as diabetes, pregnancy, hypothyroidism, hypothyroidism, or irritable bowel syndrome.

Muscular disease
Neurological disorders can affect the compression of the colon and rectum muscles. Therefore, it can result in the residue of the stool within the digestive tract and can lead to constipation. Such as nerve damage from diabetes Degenerative MS, Parkinson’s disease, Spinal cord injury Including cerebrovascular disease.

Obstruction in the intestines
Certain conditions that cause a blockage inside the colon or rectal area can make it difficult for the stool to move out of the digestive tract or get stuck in the intestines. Such as perineal ulcers, intestinal obstruction, colon cancer, pelvic floor prolapse, etc.

In addition, certain daily living habits or other factors may be more conducive to constipation, such as:

  • Stress or pressure
  • Psychological problems
  • With dehydration and mineral salts
  • An elderly age
  • Too much or too little weight
  • Drink less water
  • Hold the stool
  • Eat foods that have less fiber
  • Less body movement

Constipation diagnosis
A doctor can diagnose constipation by asking a patient’s medical history. Daily life Bowel behavior, General physical examination to assess the symptoms initially. However, in some cases with severe symptoms, additional tests may be required at the doctor’s discretion. In order to confirm the examination results together with the data obtained from the historical seizures And find the cause of undetectable constipation as follows:

Rectal exam
It is an examination of diseases that may cause constipation. The doctor will wear gloves that have a lubricant coating. Then use your fingers into the anus. To find out if there is an abnormality or not.

Blood test
This is a test that helps doctors find out if constipation is a common cause or not. In particular, the function of the thyroid hormone that causes hypothyroidism or hypothyroidism.

Abdominal X-ray
It is radiography of the distal intestine and rectum of the patient. With enema with barium powder as a contrast agent to see the movement of the stool through the X-ray machine.

Examination of the distal bowel and rectal sphincter
This is to detect abnormalities in the muscles that control excretion. By swallowing a capsule with an opaque stripe which can be seen when the x-ray and see the movement from the X-ray examination continuously.

Endoscopy
Is a partial examination of the function of the colon (Sigmoidoscopy) or the entire colon (Colonoscopy) with a specialized medical camera. Which will be inserted into the anus.

Rectal sphincter examination
The doctor will insert a tube with a small balloon attached to the end of the device into the rectum. Then have the patient try to force it out. Which the machine can measure pressure or compression to check the work of the muscles and nerves of the anus.

Constipation treatment
Constipation can be treated in a number of ways. By having to look at the main reasons that cause constipation This can be done by:

Adjustment of lifestyle and diet.
It is a treatment for mild constipation and helps relieve symptoms without medication. Which doctors may have the advice to modify some behaviors such as

  • Drink at least 2 liters of water to avoid dehydration and does not make the stool too hard.
  • Exercise by walking for 10 -15 minutes several times a day to train the muscles to function normally.
  • Adjust the bowel habits to a time each day. There should be no restraint or urge to urinate.
  • Do not use laxatives for more than 1 week and should consult a doctor or pharmacist before using the drug.
  • Eat at least 18-30 grams of high-fiber foods per day, especially fresh fruits and vegetables, whole grains, or add bulking agents (Bulking Agents) to your diet, such as wheat bran, to help keep your stools very soft. More and easier to excrete.

Drug therapy
When the above behavior adjustments have not improved constipation. Taking the drug will make it easier to pass the stool. Which the drug can be divided into many types and each act on the digestive tract differently, such as:

  • Fiber laxatives (Fiber Supplements) will increase the volume in the stool, and some contain substances that have the ability to absorb water well. The feces are soft and easily emptied, such as Psyllium, Polycarbophil, Methylcellulose Fiber.
  • Stimulants Drug, to stimulate intestinal peristalsis to work better, such as Dulcolax, Bisacodyl, Sennosides.
  • Osmotic Laxatives will act to absorb more water back into the colon. The stool is not dry and hard to discharge, such as Magnesium Hydroxide, Lactulose, Magnesium Citrate also contains poly drugs. Polyethylene Glycol (PEG) or Macrogol is a powdered laxative mixed with clean water. Suitable for the elderly, children, or people who have trouble swallowing tablets.
  • Fecal lubricant (Lubricant) is a drug that increases the slippery intestinal tract. The feces will move more easily, such as mineral oils.
  • Drugs that help soften stools (Stool Softeners) have the effect of helping to soften the stool so that it is easy to move through the intestines, such as drugs in the Docusate group (Docusate Sodium / Docusate Calcium).
  • Suppositories and fecal catheterization (Suppositories / Enemas) Suppositories soften the stool and increase the bowel movement of the stool, such as Sodium Phosphate, but in the case of very hard stools, a blocked stool catheterization may be recommended. It could be an enema with plain water, soapy water, or a ready-made stool enema containing Bisacodyl or Glycerin, and then treated with drugs.

Synbiotic treatment
It is an alternative treatment resulting from the introduction of beneficial microorganisms like probiotics and microbial food such as prebiotics come together to be synbiotic. Because some synbiotics may help strengthen the digestive system to work better. By helping to relieve constipation, diarrhea, or irritable bowel syndrome. A study of the efficacy of a synbiotic was compared with a placebo in 100 patients with constipation, with three months taking either a synbiotic or a placebo.

The results showed that the patients who took the synbiotic had soft stools and the feces were excreted from the intestines faster than the placebo group. Taking synbiotics may help relieve constipation. The above research was conducted in a small sample. Further studies are therefore needed to confirm the efficacy and safety of synbiotic therapy in the future.

However, only certain synbiotics are available in the direct treatment of constipation. Nowadays, synbiotics have been developed in a form that is easy to buy and eat. Also, no serious side effects have been found after consumption. It may therefore be used as one of the treatment options to promote intestinal health. But for those who want to use Synbiotic in the treatment of disease, A healthcare professional should be consulted about safety and appropriate dosage. Especially people with underlying diseases or pregnant women.

Pelvic floor muscle training or Biofeedback Training.
It is an exercise control and relaxation of the pelvic floor muscles. The device will be inserted into the anus. The physical therapist will then tell the patient to try to tighten or loosen the muscles. The inserted instruments record and assess the function of the muscles that aid in defecation.

Surgery
It is usually used if the other treatments listed above have not worked well and the constipation is severe. Which may be caused by intestinal obstruction, narrowing, or slack The doctor may have surgery for the colon at some point.

Constipation complications
Constipation generally rarely causes serious complications. Patients may experience pain during bowel movements. However, more frequent constipation may result in the residue of stool remaining in the intestines until it becomes dry and hard. Making it difficult to emptied or to rub against the intestinal wall and rectum while taking, Therefore may cause blood transfusion In some cases, it may develop a crack around the anus or hemorrhoids. Due to the need to force to pass the stool.

Constipation prevention
Constipation can be prevented by drinking enough clean water each day. To keep the body hydrated and prevent dehydration. Except in some cases where drinking water affects the condition of the body or the current disease. This includes avoiding excessive caffeine, alcohol, and soda. Because it will make the body more dehydrated.

Diet: Choose foods that contain more fiber (approximately 30 grams per day), especially fruits and vegetables. By gradually increasing the amount of eating up little by little to prevent bloating and in some cases, constipation may occur from eating dairy products. Therefore, it should be avoided or eaten in small quantities.

You should also be exercising regularly for about 30 minutes a day or trying to move around in your daily life more often to help you work your muscles better. Including adjusting the bowel habits to be on time, Do not hold the stool when pain occurs unnecessarily and if you find unusual symptoms, you should see a doctor This will prevent constipation from becoming more chronic or severe.

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