Treatment of constipation in older people

As the years go by, it can be increasingly difficult to go to the bathroom, which is why it is common for older people to suffer from constipation. These are some treatments that you can consult with your doctor.

In the treatment of constipation in the elderly, as in other pathologies, a diagnosis must be established and the situation, results and safety of each proposed therapy must be periodically evaluated. These different treatment options are:

Options against constipation in the elderly

  • In the case of chronic constipation, it works, where a secondary cause has been ruled out and in geriatric outpatients, it is initially recommended to change lifestyle habits, change diet, and increase fluid intake and physical activity. The next step is to take fiber supplements. Wheat fiber is the one that produces the greatest increase in fecal weight, followed by fruits and vegetables. In case it is difficult to increase the fiber in the diet, fiber supplements such as methylcellulose or plantago ovata can be administered.
  • If constipation persists, once the pathology has been ruled outosmotic laxatives, such as lactulose / lactithiol or magnesium hydroxide, should be given. It should be remembered that these drugs should be used with care in patients with heart or kidney failure, especially in the latter, in which hydroelectrolyte alterations or hypermagnesemia could occur. Bulk-forming laxatives and osmotics are associated with increased frequency and improved stool consistency and symptoms of constipation. Among the most recommended laxatives are polyethylene glycol and lactulose. It is important, in the case of polyethylene glycol, to avoid it in patients with swallowing disorders, due to the risk of chemical pneumonitis.
  • If the problem is not solved, stimulant laxatives, such as bisacodil or sennosides, can be added.
  • The emollients, such as mineral oil or paraffin, are not to be of choice in geriatric patients with functional constipation. On the other hand, its continued use can decrease the absorption of certain fat-soluble vitamins. They can be used occasionally in patients with anorectal pathology such as hemorrhoids, fissures that induce defecatory pain, etc. They can be administered orally or in the form of a suppository.
  • The pro kinetic are indicated in patients with chronic disorders of intestinal motility, neurodegenerative diseases such as Parkinson’s disease or motor disorders such as primary source Ogilvie syndrome.
  • There is a need to prescribe a laxative simultaneously with the indication of any treatment with opioids. For end-of-life palliative patients, the increase in fiber can cause more problems than benefits.
  • Enemas and suppositories, such as glycerin, are useful in short and specific treatments, but unsuitable as long-term single treatments.
  • Physical measures: abdominal massage techniques in dependent elderly have been shown to accelerate colonic transit.
  • Surgery: reserved only for severe refractory cases in which medical treatment has failed.

Likewise, in the elderly it is interesting to take into account a series of tips to avoid the establishment of constipation and thus avoid the complications and associated morbidity.

General advice

Maintain a good bowel rhythm

It is important to re-educate the individual, so that they can identify their intestinal rhythm and modify the negative attitudes that inhibit this stimulus. It is useful to recommend that you go to the toilet regularly, when you get up in the morning. It is also necessary for the person to walk and wander, especially after meals, to regain the gastrocolic reflex, which occurs approximately 30 minutes after eating. Some people may find a diary to record the time and characteristics of bowel movements in this relearning process.

Dietary fiber

In western societies a frequent cause of constipation is a poor intake of fiber. The recommended daily amount is 20-35 g / day. So older people should be encouraged to increase their fiber intake to the recommended amounts, consuming vegetables, fruits, whole wheat bread or wheat bran, etc. In people with low fiber intake, consumption should be increased progressively, since a rapid increase can lead to flatulence and digestive discomfort.

Non-pharmacological interventions also include the consumption of guar gum, bran, lentils, aloe vera, and fruits. Some of them act by increasing dietary fiber, while others act by increasing the stimulating action. The aloe vera is a popular remedy that, like rhubarb contains anthraquinone derivatives with stimulating effect. The fruit can work by increasing fecal mass and ingested and fermented fluid in the colon.

Adequate hydration

An adequate level of hydration is considered important for a good intestinal transit. At the level of the last section of the colon, the reabsorption of water from the feces occurs, which in the case of patients with a low degree of hydration can favor fecal impaction.

Regular exercise

There are data from observational studies that suggest that a low level of physical activity leads to a doubling of the risk of constipation. Prolonged bedtime and immobility are also associated with constipation. Patients should be encouraged to maintain a degree of physical activity to increase bowel regularity.

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