Constipation

Introduction

Constipation is defined as decrease in stool frequency, hard stool, difficulty in passing out feces and feeling of incomplete bowel evacuation. The overall prevalence of self reported constipation in the elderly is 24-37% and use of laxatives in them is 60%.

Causes

• Age related changes
• Immobility such as bed ridden elderly
• Lack of dietary fiber
• Chronic laxative abuse
• Dehydration
• Hypothyroidism
• Diabetic neuropathy
• Parkinson’s disease
• Medications especially opiates containing pain killers and cough mixtures, iron, anticholinergic and antidepressant
• Colorectal tumors
• Painful condition of the anus
• Difficulty to access toilet
• Lack of privacy

Symptoms

• Straining and passage of small hard stools
• Abdominal discomfort
• Loss of appetite
• Nausea

Complications

• fecal impaction
• intestinal obstruction
• colonic ulceration
• overflow incontinence (leakage of stool around obstructing faeces)
• excessive straining that may cause momentary blackouts, transient heart attack and transient stroke
• urinary retention and urinary tract infection
• piles
• anal fissures
• rectal prolapse
• anal pain and bleeding

Treatment

• Dietary modification and behavior changes
• Take food with high residual fiber like bran, whole grains, vegetables, and nuts
• Take plenty of prunes, melons and complex carbohydrate
• Adequate fluid intake
• Regular exercise to reduce immobility, stimulates defecation and strengthen abdominal muscle
• Judicious use of laxatives
• Lactulose
• Stimulant laxatives such as senna may be used. Take orally or rectally as suppository (bisacodyl). It can cause: fecal incontinence, abdominal cramps and dependence if used in the long term.
• Stool softerner help soften hard stool but has little relief for constipation
• Enemas is used when there is fecal impaction.
• Digital evacuation to disimpact the stool if necessary

Prevention

• Regular exercises especially walking
• Develop good bowel habit: answer the call to defecate as soon as possible
• Allow time to have good breakfast and then sit in toilet
• Take adequate dietary fibre, food with good bulk like potato, banana, cauliflower, peas, cabbage, lettuce, apple and carrot.
• Take plenty of fruits either fresh or dried.
• Some fruits have laxative effects
• Take plenty of vegetables.
• Take plenty of fluids especially plain water and fruit juices.
• Avoid prolong use of laxatives.
• Improving access to toilet.