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Constipation in the Elderly
Dr. Khan received her medical degree from University of Punjab and is currently a visiting scientist in the Division of Geriatric Medicine at Saint Louis University Health Sciences Center.
Constipation is a very common complaint among older persons. It is defined as defecation less than three times a week or straining on defecation at least a quarter of the time.(1) Though many consider defecation every day as a sign of good health, this is not necessarily the case. Constipation can be classified into two types: functional and rectosigmoid outlet delay.(2)
The prevalence of constipation is not known. However, in the U.S., a distinct geographic distribution exists that may suggest three global environmental factors: rural living, colder temperature and low socio-economic status.(3)
Risk factors include:
Diet and ConstipationIt is not entirely clear how diet and constipation are related. Decreased caloric intake and/or dehydration may be the cause of constipation in some patients. Lack of dietary fiber may be related to constipation.5,7 Foods high in fiber, such as 100% bran cereals, beans, peas, raspberries and broccoli, can help but, in addition to eating these foods, the person needs to be physically active and drinking adequate amounts of fluid.
Laxative AbuseA large number of people use laxatives to self-medicate constipation. This is not a good idea, especially if they are used regularly. Chronic laxative use can injure the nerves and muscles of the colon. As a result, a chronic abuser may develop a serious condition, megacolon, where the colon becomes as flabby as an overblown balloon and is unable to push along the waste matter, thus worsening the constipation.
CausesConstipation is a symptom of many diseases. If you are concerned about constipation, it helps to keep a diary of bowel habits, recording stool frequency, consistency and straining. Colon cancer may cause any kind of change of bowel habits in the elderly and should always be considered a possibility. Decreased food intake can also cause constipation, as can an underactive thryoid (hypothyroidism), an overactive parathyroid (hyperparathyroidism), depression, dehydration, scleroderma (a connective tissue disease), Parkinsonism, stroke and diabetes, all of which are potentially treatable causes. Constipation may occur in an acutely hospitalized patient due to bed rest and altered dietary routines. Pain, fever, urinary or fecal incontinence, diarrhea and/or delirium may appear in persons with prolonged constipation (fecal impaction). Impaired, bed-bound patients with neurological complications may develop a twisting of the gut called volvulus. Volvulus can produce intestinal obstruction, a serious condition, causing sudden abdominal distention, cramping and vomiting and requiring immediate medical treatment.
Drugs Causing Constipation
Taking certain medicines may cause constipation:
Laxatives (used chronically)
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