Constipation: Types, Causes, Complications, and Management

Introduction:

A lot of things in our bodies change as we age. Our system slows down and loses efficiency, diets change, and living situations shift. Reaching the age of 60 and above is a risk factor for constipation and other diseases. Women experience constipation more than men, but everyone experiences it as a factor of general aging. The frequency of constipation increases throughout adulthood and becomes more advanced after 60 years of age. Adults with chronic constipation make up about 16 % of the population, and this proportion rises to half for people residing in nursing homes. A person having constipation can experience strain during bowel movements, production of hard and lumpy stools, a nagging feeling to evacuate after bowel movements, a sense of something blocking the stools, and the need to induce bowel movements physically.

What Are the Types of Constipation?

There are two types of constipation in people of all ages:

• Primary.

• Secondary.

When the issue is with bowel function and is brought on by another medical condition or medicine, it is primary constipation, also referred to as functional constipation. The three subgroups of functional constipation are distinguished as-

• Normal Transit Constipation- It is the most typical type and is characterized by frequent firm stools that are challenging to pass.

• Slow Transit Constipation- The bowel itself travels stools slowly for various reasons, but in slow transit constipation, there is a delay in emptying the bowel. People who suffer from metabolic diseases like hypothyroidism and diabetes frequently experience this.

• Disorders of Defecation- Stool builds up in the colon without being expelled when defecation disorders occur because issues with the rectum’s musculature decrease the urge to urinate.

In the case of secondary constipation, gastrointestinal issues arise as a result of another structural, physical, or medical problem. For example, using more than five prescription drugs, having a long-term illness, and exhibiting mental health issues.

What Are the Causes of Constipation?

There can be various reasons leading to constipation in the elderly, including-

• Decreased calorie intake, dehydration, and a lack of dietary fiber are the primary reasons.

• One of the causes of constipation is lack of exercise.

• Reduced mobility is common in older adults and people who cannot walk around easily and often have sluggish bowels. It may be because their intestines are slow.

• Older residents who take a long time to walk to the toilet because of pain may try to avoid going to the bathroom.

• Diet is a crucial factor in preventing constipation, but some elderly residents do not eat large meals to trigger a bowel movement, and their diet may not contain sufficient fiber to produce bulk in the intestine.

• Some elderly people do not have enough fluid throughout the day because they worry about incontinence of urine. Unfortunately, a low fluid intake can contribute to constipation.

• There are several drugs that can cause constipation, such as antacids or painkillers, which contain Codeine. These medications make the intestines move more slowly. Diuretics or water pills take water out of the intestine, making it more difficult to have a bowel movement.

• Many people use laxatives to self-medicate, which is not a good idea as certain chronic laxatives can enter the nerves and muscles of the colon, further increasing constipation.

• Constipation is a symptom of many diseases, such as thyroid problems, depression, Parkinson's disease, stroke, and diabetes.

What Are the Complications of Constipation?

Complications of constipation include fecal impaction (hard stool stuck inside the lower colon or rectum), hemorrhoids (swelling in the anus also causing bleeding), anal fissures (a small tear in the lining of the anus), and rectal prolapse (a part of the large intestine slips into the anus).

• The abdomen may become distended, hard and diffusely tender in the later stages of constipation.

• Severe cases may exhibit symptoms of bowel obstruction, nausea and vomiting, tender abdomen, and encopresis (unintentional leakage of stool in underclothes), in which soft stool from the small intestine bypasses the impacted stool in the colon.

• The stool can become hard and dry and harder to evacuate when it builds up in the large intestinal colon for a long duration of time, leading to colon thickening.

How to Manage Constipation in Older Adults?

Ideally, constipation can resolve on its own without the use of medications. The first step in treating constipation is to manage symptoms like abdominal pain and bloating. The second step is achieving regular and soft bowel movements that do not require a person to strain at least three times a week.

• Eating fiber-rich foods and adding more fruits and vegetables, cereals, or nuts to the diet.

• Drinking sufficient amounts of water and intaking natural fruit juices.

• Exercise is the key. An elderly should at least do a light jog or short walk every day.

• Avoid sugary, processed, and fast foods.

If non-medical methods do not work, then seek medical help. A doctor might examine the patient for fecal impaction- a condition that develops when hard and dry stool gets stuck into the colon, making it difficult to pass. This condition is treated either by enema (injections of fluids that help cleanse or empty the bowel) or by manual disimpaction (a gloved and lubricated index finger is inserted inside the rectum, and the stool is taken out in parts).

For constipation that is not impacted, several other behavioral options are available-

• Scheduling toileting efforts after meal time.

• Maintaining a regular pattern to attempt a bowel movement.

• Use of a stool under the feet during a bowel movement.

• Proving the person adequate time and privacy.

• Avoiding bedpans.

Medication options can be given based on the type of constipation a person has, and most of these are available over the counter, such as-

• Bulking Agents- These medications add bulk to the stool to increase the urge to have a bowel movement. Examples are methylcellulose powder fiber supplements, psyllium fiber, etc.

• Osmotic Laxatives- They work by attracting water to the colon and help keep the stool soft and hydrated to make bowel movement easier. Examples- are lactulose solution, magnesium citrate solution, sorbitol solution, etc.

• Stool Softeners- They do what they say; they make the stools easier to pass. Example- Docusate sodium capsules.

• Stimulant Laxatives- They trigger contractions in the intestines, further pushing the stool. Example- Bisacodyl.

Conclusion:

While manageable, constipation still poses serious health problems; no matter the age, constipation is uncomfortable. However, it is a more prevalent illness that can have dangerous side effects in older persons, particularly those with dementia or Alzheimer's disease. So modifying the diet, increasing fluid intake, and exercising are the basic steps that are needed to manage this condition.