Constipation

The constipation may be defined as the passage of stool in small amounts, hard, dry, or absence of deposition for a certain period of time, generally greater than several days.

For its part, fecal impaction is understood to be the accumulation of hard stools in the rectal ampulla and in the distal portion of the large intestine with impossibility of its expulsion.

Both situations represent an important health problem in the elderly due to their biological and socio-sanitary repercussions.

Causes of constipation

There are several circumstances that favor constipation and fecal impaction. The most important ones are:

• Decreased physical activity or mobility disorders, especially in bedridden people. It produces progressive weakness in all muscles, including those involved in the defecation process, such as the abdominal muscles.
• Decreased fluid intake. Older people, due to alteration of the thirst center, located in the central nervous system , do not feel thirsty and stop drinking enough fluids.
• Decreased fiber intake in the diet.
• Having irregular bowel habits: When the need for defecation is not responded to, the stool becomes more compact.
• The use of laxatives and enemas continuously causes the intestine to require increasingly higher and more frequent doses of these drugs to achieve the same effect. They are responsible for chronic constipation.
• Environmental situations such as lack of privacy to carry out the deposition. For example: elderly people who are hospitalized or who share the same room with other people.
• Difficulty accessing the bathroom.
• Diseases of the digestive system .
• States of anxiety and depressive disorders.
• Dementias (one of the manifestations is a decreased response to defecation).
• Changes in the digestive system typical of age: decreased intestinal motility, atrophy of the intestinal mucosa and decreased secretions and alterations in intestinal innervation.

Symptoms of constipation

It is characterized by the following facts:

• Decreased frequency of bowel movements.
• Hard and dry stools.
• Effort to perform the deposition.
• Feeling of fullness and / or bloating.
• Loss of appetite
• Diffuse abdominal pain, sometimes.

How is it diagnosed?

Due to the clinical manifestations described above. It may be necessary to perform various complementary tests such as a rectocolonoscopy (a technique that involves introducing a flexible tube through the rectum, equipped with a fiber optic system, to visualize the large intestine).

It is possible to know, through this test, if there are pathological processes in the colon: tumors, spasms, dilations or diverticula (small dilations, in the form of sachets, of the large intestine that occur when fragments of the intestinal mucosa herniate through the fibers muscles that form the wall of the colon).

A black enema may also be done. It consists of the introduction of an X-ray opaque contrast through the rectum. This contrast fills the entire large intestine; later, serial radiographs will be taken. It allows to see the same alterations of the intestine previously described.

Treating constipation

Non-pharmacological measures :

• Increase your fluid intake: at least 2 liters a day.
• Increase the consumption of foods rich in fiber (whole grains, bran, fruits, legumes, vegetables …). You can take the fruits without peeling.
• Perform exercises to strengthen the abdominal muscles: Lying on the back, the older person will pull the abdominal muscles inward, holding this posture for several seconds. You will do this exercise 5-10 times a day, depending on your health. It is not convenient to do it if the elderly person suffers from poorly controlled high blood pressure or severe heart disease.
• Establish a daily elimination habit: For example, go to the bathroom after breakfast. The desire for defecation should not be inhibited: go to the bathroom when you feel the need and not wait to get home.
• Avoid both pharmacy and herbal laxatives: the body gets used to them, making it necessary to increase the dose or the frequency of their administration. In addition, some are especially irritating to the intestine and can cause pain and complications. Enemas can also cause loss of fluids and mineral salts in older people and cause serious situations.

Pharmacological measures :

• They should always be prescribed by the doctor. You cannot take laxatives on your own.
• The doctor will advise which one is the most appropriate according to the condition and needs of the elderly person.
• Medications used for constipation can be applied orally (pills, powders, granules, syrups) or rectally (suppositories, microenemas, or enemas).
• To administer a suppository, the person who is going to administer it puts on a latex glove and lubricates it with a specific substance, for example, a urological lubricant. Then the suppository and the entire finger must be inserted through the anus.
• Subsequently, the elderly person should be advised to keep the buttocks contracted so that the suppository is not expelled.
• Enemas consist of solutions of liquids and various substances. They produce distention and irritation of the large intestine with increased motility, which favors the elimination of accumulated feces.
• Nurses at health centers will teach you the correct way to administer enemas and the precautions to take.

Fecal impaction

Treatment should be carried out by the doctor after rigorous evaluation, since other processes such as intestinal obstruction can begin with similar symptoms. Sometimes hospitalization may be necessary and in the most serious cases, which are not solved with conservative measures, surgical intervention.

How can I avoid it?

General recommendations to facilitate a regular bowel habit:

1. Non-pharmacological measures previously commented.
2. In older people who use the bathroom independently, it is advisable to adopt a suitable position when making a bowel movement: the older person will stand upright with their feet flat on the floor, with their knees and trunk flexed. in a semi-squat position, as much as possible. You can perform upper body rocking movements to facilitate more comfortable removal of stool, without putting too much pressure on the abdominal area.
3. In bedridden elderly people it is necessary to use a wedge, directing the narrowest area towards the back because it facilitates positioning better, especially if the elderly person cannot raise their legs (see figure).
4. If there is no contraindication, massages in the abdomen and gluteal region are beneficial, since they provide stimulation of the large intestine and relaxation of the anal sphincter. For the massage to be effective it is necessary that the older person is lying on a firm surface. The massage begins on the right side of the abdomen, making circular movements in a clockwise direction (see figure). Each time a greater pressure is applied without it becoming painful. Massage in the gluteal region is performed by placing the elderly person face down, if he tolerates this position well. Deep frictions are performed that begin in the sacral region and work downward and outward. You can also perform kneading and pressing movements with closed fists, taking care not to cause pain.