IT is not uncommon for an older person to complain of constipation or delayed colon emptying. The regular bowel habits become an every other day or every three days activity. This leaves the older person anxious; they worry about the possibility of infection and other colonic problems that may arise from the apparent “constipation.”
Constipation is defined as a change in bowel function consisting of diminished frequency of defecation and often increased difficulty with defecation.
Impaction is the end result of prolonged exposure of accumulated stool to the absorptive forces of the colon and rectum. Several reasons why older people suffer from it include decreased physical mobility and low-fiber diets leading to prolonged colon-transit time and failure of the defecation mechanism called dyschezia. Systemic diseases such as hypothyroidism, uremia, hypercalcemia, depression, parkinsonism, cerebrovascular accidents and diabetes may cause difficulty in defecation. Some drugs, like anticholinergics, aluminium hydroxide, calcium channel blockers, iron and nonsteroidal anti-inflammatory drugs may cause delay in colonic emptying. Older persons come in the clinic usually complaining of a change in the frequency of their bowel movement. Sometimes they refuse to eat or take their medication because of the feeling of fullness.
How do we manage constipation? Doctors will more likely treat underlying systemic diseases especially depression. They may replace potassium and magnesium and remove or replace all offending medication. Doctors may also give glycerine suppositories at certain intervals, taking note of the normal gastrocolic reflex which comes after food intake. We will also encourage increased mobility and increase in the daily intake of fluids and dietary fiber.
Once constipation or impaction is treated, steps should be taken to prevent recurrence. We have to encourage continuation of exercise and increase in dietary fiber. Help them regularize their bowel pattern.
As patients, you should ask your doctors of the possible side effects of the drugs they prescribe, to choose a less-constipating alternative or by adding a laxative.
Caretakers should also be educated regarding constipation. Caretakers should note refusal of food or feedings because this is normal for patients who are unable to evacuate their bowels. When patients aspirate food or feedings, this can be a result of caretakers’ well-intended attempts to nourish patients. If there is really fecal impaction, it should be addressed within the first 48 hours of care.
Laxatives available in the market include bulk- forming agents (high-fiber supplements, psyllium and senna), osmotic agents (lactulose, sorbitol, glycerine suppository), stimulants (castor oil and bisacodyl), emollients and salts (milk of magnesia), and magnesium citrate.