Constipation in older people

Constipation in older people

It is one of the great geriatric syndromes due to its prevalence, its serious complications and its important impact on the quality of life of the elderly.

Despite this, it is very difficult to know the real frequency of constipation, since not all the elderly with this symptom go to the doctor, and conversely, many have a wrong idea of ​​the normal bowel rhythm. All these circumstances mask the results of epidemiological studies and also influence the significant self-consumption of laxatives among the elderly (30-50% of the elderly take them regularly or sporadically).

Even so, it is known that constipation is one of the most frequent problems among the elderly, with it being suffered by between 2 and 12% of those over 65 who live in the community and up to 80% of the institutionalized. These percentages increase exponentially with age. Likewise, it is more frequent in women than in men, in a ratio of 2 to 1.

Constipation in older people can be acute (abrupt and short-term decrease in stool frequency or straining) or chronic. The diagnostic criteria for chronic constipation are as follows:

It must include all of the following and for the past 3 months:

• Must meet 2 or more of the following symptoms:
  • Excessive defecation effort more than 25% of the time.
  • Hard stools more than 25% of the time.
  • Feeling of incomplete evacuation more than 25% of the time.
  • Sensation of blockage or anorectal obstruction more than 25% of the time.
  • Manual maneuvers to facilitate defecation (digitization, grip of the pelvic floor) more than 25% of the time.
  • Less than 3 bowel movements per week.
• He rarely has a bowel movement without the use of laxatives.
• Does not meet clear criteria for irritable bowel syndrome.

Complications of constipation

Constipation in the elderly is not always a trivial process, since, in addition to subjective discomfort and discomfort, it can be accompanied by multiple medical complications, some of them potentially serious.

The most frequent complication is fecal impaction or fecaloma, which is the accumulation of feces in the rectal ampulla, many times favored by the dehydration of the feces due to the reabsorption of water. Other complications of constipation can be anorexia, worsening of gastroesophageal reflux due to increased intra-abdominal pressure, anal pathology such as internal and external hemorrhoids, anal mucosa prolapse, and intestinal obstruction. The most serious complications, in addition to obstruction, are colon volvulus and pseudo-obstruction of the colon or Ogilvie syndrome.

An infrequent complication that must be known is the manure ulcers or stercoracia, in which the hard stools produce a decubitus on the colonic mucosa. They can manifest with rectal bleeding and in case of infection of the ulcer with fever, abdominal pain and even bacteremia, with the passage of bacteria from the intestinal tract to the bloodstream.

In frail or cognitively impaired elderly people, constipation and fecal impaction are causes to consider when presenting a picture of confusional syndrome or delirium.