old age constipation
Introduction
Introduction to old age constipation Constipation in the elderly (senileconstipation) refers to the reduction in the number of bowel movements, while difficulty in defecation and dry stool. Normal people have 1 or 2 bowel movements per day or 2 to 3 days of bowel movements. Constipation patients have less than 2 bowel movements per week, and defecation is laborious. Fecal induration is small. Constipation is a common symptom in the elderly, about 1/3. The elderly have constipation, which seriously affects the quality of life of the elderly. basic knowledge The proportion of illness: 0.02% Susceptible people: the elderly Mode of infection: non-infectious Complications: syncope, myocardial infarction, hemorrhoids
Cause
Causes of constipation in the elderly
Age related (15%):
The prevalence of constipation in the elderly is significantly higher than that of young adults, mainly due to the fact that with the increase of age, the food intake and physical activity of the elderly are significantly less, the secretion of digestive juice in the gastrointestinal tract is reduced, the tension and peristalsis of the intestine are weakened, and the abdominal cavity and pelvic floor are reduced. Muscle weakness, weakening of the internal and external sphincter of the anus, weakening of the stomach and colon, weakening of the rectum, causing the food to stay in the intestine for too long, excessive absorption of water causes constipation. In addition, elderly people often lose bowel reflexes due to senile dementia or depression, causing constipation.
Bad living habits (30%):
(1) Dietary factors, the elderly teeth fall off, like to eat low-sludge fine food, or a small number of patients map convenient, easy to eat, lack of crude fiber, so that the volume of feces is reduced, viscosity increases, slow movement in the intestine, water Excessive absorption leads to constipation. In addition, because the elderly have less food, the food contains a low calorie, and the gastrointestinal transit time is slowed down, which can also cause constipation. It has been reported that the gastric colon reflex is related to the amount of food consumed, the 1000cal diet can stimulate colonic movement, and the 350cal has no such effect. Fat is the main food that stimulates reflexes, and protein does not.
(2) Defecation habits Some elderly people do not develop the habit of regular bowel movements, often overlooking the normal intentions, resulting in inhibition of bowel movements and constipation.
(3) Activities to reduce the number of elderly people due to certain diseases and obesity, resulting in reduced activities, especially in patients who are sick or in wheelchairs, because of the lack of exercise stimulation to promote the movement of feces, often susceptible to constipation.
Mental and psychological factors (35%):
People with mental disorders such as depression, anxiety, obsessive-compulsive disorder are prone to constipation. According to studies by Merkel and others, the scores of depression and anxiety in patients with 1/3 constipation are significantly higher.
Intestinal lesion
Intestinal lesions include inflammatory bowel disease, tumor, hernia, rectal prolapse, etc., such lesions lead to functional outlet obstruction causing defecation.
2. Systemic disease
Systemic diseases include diabetes, uremia, cerebrovascular accidents, and Parkinson's disease.
3. iatrogenic (abuse of laxatives)
Due to the long-term application of laxatives, especially irritating laxatives, the colon can cause catharsis due to damage to the knot and rectal muscle, causing damage to the intestinal mucosal nerves and reducing intestinal muscle tension, which in turn leads to severe constipation. In addition, other drugs that cause constipation are, for example, opioid analgesics, anticholinergics, antidepressants, calcium antagonists, diuretics, and the like.
Normal bowel movements include two processes of creating a bowel movement and a bowel movement. After the meal, it is reflected by the stomach colon, the colon movement is enhanced, and the feces are advanced to the distal end of the colon. When the rectum is filled, the internal sphincter of the anus relaxes, and at the same time, the external anal sphincter contracts, causing the intra-rectal pressure to rise, and the pressure stimulation exceeds the threshold to cause the intention. This impulsive impulse travels along the pelvic and sub-abdominal nerves to the defecation center of the lumbosacral spinal cord, and then through the thalamus to the cerebral cortex. If conditions permit, the puborectalis and anus internal and external sphincters are loose, both sides of the levator ani muscle contract, the abdominal muscles and diaphragm muscles also coordinate contraction, abdominal pressure increased, prompting the discharge of feces. In the elderly, the resting pressure of the muscles is generally reduced, the elasticity of the mucosa is also weakened, and even the sensitivity and reactivity of the receptors around the anus are decreased, so that the feces tend to accumulate in the ampulla and are unable to be discharged. Cerebral vascular sclerosis in the elderly is prone to cerebral cortical inhibition, and the gastric colon reflex is slowed down, which is prone to constipation. Recent studies have shown that blood gastrointestinal hormones are involved in the control of colonic motility, such as vasoactive intestinal peptide, plasma pancreatic polypeptide, motilin, growth hormone, and cholecystokinin. Hormone changes may play a major role in the development of constipation in the elderly.
Prevention
Elderly constipation prevention
Dietary fiber is important for changing the nature of feces and defecation habits. The fiber itself is not absorbed, it can expand the feces and stimulate the movement of the colon. This may be more effective for constipation patients with less dietary fiber intake. The food with the most dietary fiber is wheat bran. There are also fruits, vegetables, oats, corn, soybeans, pectin, etc. If there is fecal impaction, the feces should be discharged first, and then dietary fiber should be added.
Complication
Complications of constipation in the elderly Complications, syncope, myocardial infarction, hemorrhoids
Excessive forced defecation can induce TIA or defecation syncope, and even in the case of atherosclerosis complicated by myocardial infarction and stroke, constipation can cause or aggravate hemorrhoids and other perianal diseases, intestinal obstruction after fecal impaction, feces Ulceration, urinary retention and fecal incontinence, as well as spontaneous perforation of the colon and sigmoid torsion.
Symptom
Symptoms of constipation in the elderly Common symptoms Defecation difficulty Fecal induration such as sheep fecal bloating Gastrointestinal symptoms Fecal amount less Abdominal pain Dry stool Colonic constipation
The main manifestations of constipation are reduced bowel movements and difficulty in defecation. Many patients have fewer than 2 bowel movements per week. In severe cases, they have a bowel movement for 2 to 4 weeks. However, the reduction is not the only or necessary for constipation. Performance, some patients can be prominently expressed as difficulty in defecation, defecation time can be up to 30min or more, or multiple bowel movements every day, but the discharge is difficult, the fecal induration is like sheep feces, and the number is small, in addition to abdominal distension, reduced food intake And the improper use of laxatives caused abdominal pain before defecation, physical examination of the left lower abdomen with intestinal sputum, feces in the anus.
Constipation may be the only clinical manifestation, or it may be one of the symptoms of a certain disease. For patients with constipation, you should know the medical history, physical examination, and if necessary, further examination to determine whether there is mechanical obstruction of the digestive tract, with or without power. obstacle.
Physical examination can find some evidence of constipation, such as the presence or absence of dilated bowel in the abdomen, whether it can touch the intestinal tract of feces, anal and rectal examination, can be found with rectal prolapse, anal fissure pain, anal canal stenosis, With or without caulking, it is also possible to estimate changes in anal canal tension at rest and during forced bowel movements.
Examine
Elderly constipation check
1, stool examination
Observe the shape, size, firmness of the feces, whether there is pus and mucus, etc. In the rectal constipation, due to the relaxation of the rectal smooth muscle, the discharged feces are mostly blocky; while the sputum colon constipation, the feces are sheep feces, feces Conventional and occult blood tests are the subject of routine examinations.
2, rectal examination
It can help to find rectal cancer, hemorrhoids, anal fissure, inflammation, stenosis, hard fecal blockage and external compression, anal sphincter spasm or relaxation. When rectal constipation, there can be a lot of dry dry mass in the rectum.
3, gastrointestinal X-ray examination
Gastrointestinal barium meal examination has reference value for understanding gastrointestinal motility function. When normal, tincture can reach colon spleen area within 12~18h, all should be discharged from colon in 24~72h, and there may be delay in emptying during constipation, barium enema In particular, the use of colonic low-tension double contrast in recent years may be helpful in the cause of constipation.
4, special inspection
Swallow a certain number of X-rayed hose fragments as a marker, and regularly take the laps to understand the speed and distribution of the markers in the gastrointestinal tract. For example, rectal constipation, visible markers are running in the colon. Fast, and finally accumulate in the rectum; if it is colon constipation, the marker is distributed between the jejunum and the rectum.
Diagnosis
Diagnosis of elderly constipation
According to the situation, some special examinations should be selected. Firstly, organic diseases such as colon cancer and constipation caused by stenosis should be excluded. Abdominal plain film can show intestinal dilatation and fecal retention and gas-liquid level. Endoscopic or imaging examination should be performed to understand colon and rectum. The structure of the intestine, fiber sigmoidoscopy can observe the mucosa of the rectosigmoid and the presence or absence of lesions and stenosis in the cavity, and can also find melanosis coli, which is caused by long-term use of sputum laxatives to cause lipofuscin Performance.
