What Is Constipation?

Elderly constipation means that the number of defecations is reduced, while defecation is difficult and the stool is dry. Normal people defecate 1-2 times a day or once every 1-2 days. Patients with constipation defecate less than 3 times a week. Constipation is a common symptom of the elderly. About 1/3 of the elderly suffer from constipation, which seriously affects the quality of life of the elderly.

Basic Information

English name: Constipation
Visiting department: Gastroenterology
Multiple groups: Seniors

Common causes: Related to old age, poor living habits, mental illness, intestinal diseases, systemic diseases, drug abuse, etc.
Common symptoms: Reduced bowel movements, difficulty in defecation, firm stools and less volume; bloating, lack of appetite

Causes of constipation

Related to age

The prevalence of constipation in the elderly is significantly higher than in young adults, mainly because with the increase of age, the elderly's food intake and physical activity are significantly reduced, the secretion of digestive juice from the gastrointestinal tract is reduced, the tension and peristalsis of the intestines are weakened, and the abdominal cavity and pelvic floor Muscle weakness, weakened internal and external anal sphincter, weakened gastric and colon reflexes, decreased rectal sensitivity, made food stay in the intestine too long, and excessive absorption of water caused constipation. In addition, older people often lose defecation reflexes due to senile dementia or mental depression, causing constipation.

2. Bad living habits

(1) Dietary factors Elderly people lose their teeth, prefer to eat low-residue fine food, or a few patients, it is convenient and saves time, the diet is simple, the lack of crude fiber, which reduces the volume of feces, increases the viscosity, slows the movement in the intestine, and hydrates. Excessive absorption causes constipation. In addition, because the elderly eat less food, the calorie content of the food is low, and the gastrointestinal transit time is slowed down, which can also cause constipation. It has been reported that gastrocolonic reflex is related to the amount of food eaten, a 1000 cal diet can stimulate colon movement, and 350 cal has no such effect. Fat is the main food that stimulates reflexes, while protein has no effect.

(2) Defecation habit Some elderly people do not develop the habit of regular defecation, and often ignore the normal defecation, resulting in suppression of defecation reflex and constipation.

(3) Reduced activity Elderly people have reduced activities due to certain diseases and obesity factors, especially those who are bedridden or wheelchair-bound due to the lack of exercise stimuli to promote the movement of feces and are often prone to constipation.

3. Psychological factors

People with mental disorders such as depression, anxiety, and obsessive-compulsive disorder are prone to constipation.

4. Intestinal lesions

Intestinal lesions include inflammatory bowel disease, tumors, hernias, rectal prolapses, etc. These lesions cause functional outlet obstruction and cause defecation disorders.

5. Systemic lesions

Systemic diseases include diabetes, uremia, cerebrovascular accident, and Parkinson's disease.

6. Iatrogenic (abuse of laxatives)

Long-term use of laxatives, especially irritating laxatives, causes damage to the intestinal mucosal nerves, reduces intestinal muscle tension, and causes severe constipation. In addition, other drugs that cause constipation include opioid analgesics, anticholinergics, antidepressants, calcium antagonists, and diuretics.

Clinical manifestations of constipation

The main manifestations of constipation are reduced bowel movements and difficulty in defecation. Many patients defecate less than 3 times a week, and in severe cases, defecation occurs only once every 2 to 4 weeks. Some patients can be marked by difficulty in defecation. The defecation time can be as long as more than 30 minutes, or defecation can be repeated several times a day. In addition, there are abdominal distension, lack of appetite, and abdominal pain before defecation caused by improper use of laxatives. On the left lower abdomen, there was a bowel loop with fecal deposits and anal examination with fecal mass.

Excessive defecation in the elderly can cause changes in coronary arteries and cerebral blood flow. Due to the decrease in cerebral blood flow, fainting may occur during defecation. Coronary arterial insufficiency may cause angina pectoris and myocardial infarction. Hypertension can cause cerebrovascular accidents, can also cause aneurysm or ventricular aneurysm rupture, cardiac mural thrombus shedding, arrhythmias and even sudden death. Megacolonosis can occur due to low muscle tone in the colon. When defecation is forced, an increase in intra-abdominal pressure can cause or exacerbate hemorrhoids, and when ancillary defecation damages the anal canal, it can cause anal fissure and other perianal diseases. Fecal impaction results in intestinal obstruction, fecal ulcers, urinary retention, and fecal incontinence.

Constipation check

Plain abdominal film

Can show intestinal dilatation, fecal retention and gas-liquid level, can determine organic lesions such as colon cancer, constipation caused by stenosis.

2.Barium enema

Can understand the structure of the colon and rectum.

3. Colonoscopy and fiber sigmoidoscopy

Can observe the intestinal mucosa and the cavity for lesions and stenosis, and can also find colonic melanosis.

4. Anal rectal pressure measurement

Can help determine the presence of rectal, pelvic floor dysfunction, or abnormal rectal sensory thresholds.

5. Balloon ejection test

It is helpful to judge whether the function of rectum and pelvic floor muscles is abnormal.

6. Pelvic floor electromyography

Can determine the presence of myogenic or neurogenic lesions.

7. Colonic transmission function experiment

Learn about colonic transmission.

8. Defecography

It is helpful for the diagnosis of pelvic floor hernia and intussusception.

Constipation diagnosis

Learn more about the onset time and treatment history of constipation, and recent changes in bowel movement time. Ask the number of bowel movements, whether there is difficulty in defecation, whether the effort and blood in the stool are accompanied by abdominal pain and bloating. Other systemic diseases, especially to exclude organic diseases. If the course of the disease is more than a few years, and the condition does not change, more prompts functional constipation.

Constipation treatment

1. Keep up the exercise

A survey of elderly people over 60 years of age shows that constipation occurs in 15.4% of walkers due to old age and very few infirmities, while constipation occurs in 0.21% of those who exercise regularly. Walk or massage your abdominal muscles with your hands several times a day to increase your gastrointestinal motility. Long-term bedridden patients should turn over frequently, and perform circular massage or hot compresses on the abdomen.

2. Develop good bowel habits

Provide health education to help patients establish normal bowel movements. You can practice bowel movements every morning, even if you don't have a bowel movement, you can wait to form a conditioned reflex. At the same time, we must create a quiet and comfortable environment and choose a toilet.

3 Reasonable diet

Elderly people should eat more foods containing coarse fiber and vegetables, fruits, legumes, and plenty of water. Drink at least 1500 ml of water daily, especially drinking a cup of warm water every morning or before meals. In addition, you should eat some foods with laxative effects, such as black sesame, honey, bananas and so on.

4 other

Prevent or avoid the use of medicines that cause constipation, do not abuse laxatives, actively treat systemic and perianal diseases, adjust mental state, and good mental state helps to establish normal defecation reflex.

Constipation prevention

Insist on proper physical exercise, intentionally cultivate good bowel habits, reasonable diet, and pay attention to supplementary dietary fiber. The foods containing the most dietary fiber are wheat bran, fruits, vegetables, oats, corn, soybeans, pectin, and so on. In addition, it is necessary to actively treat systemic and perianal diseases, prevent or avoid the use of drugs that cause constipation, and cultivate a good psychological state, which is conducive to the prevention and treatment of constipation.