Old people often complain about constipation in the doctor's office. As a doctor, they often hear some old friends complain: "Alas, they are always constipated, and they can't get rid of it after squatting in the toilet for a long time. Sometimes they only defecate once or twice a week."
1. What is senile constipation, and what harm will it bring to the health of the elderly?
Constipation in the elderly usually manifests as reduced defecation frequency, dry stool and difficulty in defecation, and defecation is less than three times a week. Long-term constipation will cause toxins to stay in the intestinal cavity and be absorbed by the human body, thus causing headaches, dizziness, loss of appetite, insomnia and other symptoms.
The elderly will defecate forcibly because of difficulty in defecation, which may lead to angina pectoris and myocardial infarction in the elderly with coronary heart disease, and cerebrovascular accident in patients with hypertension. When you squat for a long time and defecate suddenly, you may fall down because of postural hypotension, which leads to syncope due to insufficient blood supply to the brain.
second, how does constipation happen?
Constipation occurs because the colon absorbs too much water from the residual food, which makes the feces dry and makes it difficult for the intestines to push them out of the body step by step.
It can be understood that it is precisely because food passes through the digestive tract layer by layer that nutrients will be absorbed. The remaining undigested food (waste) moves from the small intestine to the large intestine (also called colon). The colon absorbs water from this waste and produces a solid substance called feces. If you have constipation, food may move too slowly in the digestive tract. This gives the colon more time (too much time) to absorb water from waste. Feces become dry, hard and difficult to push out.
third, what causes constipation in the elderly?
(1) Drinking too little water: water can make the stool form a certain amount and volume, soften and moisten the stool, stimulate intestinal peristalsis and make it easier to be discharged. Dry, hard feces are difficult to discharge. Many elderly people are accompanied by urinary incontinence. In order to avoid urination, they may drink less water actively or passively. For the elderly with cognitive impairment, active drinking water may be reduced, and uneven and irregular eating will also lead to insufficient drinking water; In addition, mental and behavioral problems associated with cognitive impairment may lead patients to refuse to drink water.
(2) Decline of organ function: Compared with young people, the elderly people's metabolism of food in the digestive tract slows down, the functions of various organs gradually decline, the contractility of muscles is small, the rectal muscles and abdominal muscles shrink, the muscle tension decreases, and the peristalsis of the intestine slows down, which easily leads to the retention of feces in the intestine, which cannot be ruled out. Constipation is more likely to occur in some types of cognitive impairment, such as Alzheimer's disease, Parkinson's disease, Lewy body dementia and so on, because of the pathological changes of the brain nervous system.
(3) Less exercise: Some elderly people have reduced their exercise ability because of inconvenient legs and feet, and they are afraid of falling, which leads to reduced exercise. The elderly with cognitive impairment reduce physical exercise and lead to constipation because of inconvenient movement, sedentary, long-term bedridden and bedridden. Proper exercise can maintain muscle tension, stimulate intestinal peristalsis and maintain normal defecation function.
(4) Less intake of dietary fibres: Dietary fiber can promote intestinal peristalsis, thus reducing the residence time of food in the intestine, so it is helpful for defecation. The elderly, especially those with cognitive impairment, may often use some convenience foods or fast food because they live alone, are widowed or have difficulties in taking care of them. Convenience foods or fast food contain less dietary fibres. In addition, because the elderly have fewer teeth and have difficulty swallowing, they will choose some foods with low dietary fibres content when eating. All these lead to less intake of dietary fibres. Low-fiber foods that may cause constipation are:
1. Processed grains: Processed grains and their products (such as bread, white rice and white pasta), in which the dietary fiber content is lower, and the constipation degree is higher than that of whole grains. This is because the bran and germ parts of the grain are removed during processing. Bran contains cellulose, which can increase the volume of feces and help them move.
2. Red meat: As the name implies, red meat refers to meat that turns red before cooking, such as pork, mutton and beef. Eating red meat every day can lead to constipation. Red meat has no cellulose. As mentioned earlier, dietary fiber will increase the volume of feces, so that it can pass through the intestine smoothly. In addition, if you are full of red meat (although satisfied), you may eat less fruits, vegetables and whole grains.
3. Milk: This may have nothing to do with low-cellulose food, so put it together with food. Sensitivity to protein in milk is usually related to scanty stool or diarrhea, but some studies show that some people suffer from constipation due to eating milk (or other dairy products).
4. fast food: fried food and low-fiber fast food have high fat content and very low cellulose content. Will lead to constipation. Make them stable foods in your diet, and you may be at least partly responsible for intestinal obstruction.
(5) Other diseases that may cause constipation: Some common diseases in the elderly may cause constipation, such as hypercalcemia, hypothyroidism, hyperparathyroidism, chronic kidney disease, diabetes, etc.
(6) drug factors: the elderly usually have some physical diseases and need to take some drugs, such as analgesics, hypnotics, iron agents, calcium agents, antihypertensive drugs, antibacterial drugs, anticholinergic drugs, etc. Under the interaction of various drugs, intestinal peristalsis may be slowed down, the normal flora balance will be destroyed, causing intestinal dysfunction, water in intestinal contents will be absorbed by drugs, and feces will dry up. Common drugs: opioids (morphine, codeine, etc.), anticholinergic drugs (atropine, trihexyphenidyl), antidepressants (amitriptyline, fluoxetine, paroxetine, sertraline), calcium channel blockers (verapamil), anti-Parkinson's drugs (Parkinson's disease itself may cause constipation, and drugs used for this disease (including levodopa) may also cause constipation. Antipsychotics (clozapine, thiopyridazine, chlorpromazine, risperidone, olanzapine), diuretics (furosemide), antihypertensive drugs (nifedipine, clonidine, propranolol), antihistamines (diphenhydramine, cetirizine, loratadine, etc.), analgesic and non-steroidal anti-inflammatory drugs (ibuprofen, aspirin).
(7) mental state: if the elderly are accompanied by anxiety, nervousness, depression and poor sleep, it is also an important cause of constipation. If they are in a state of nervousness and anxiety for a long time, the brain will secrete some substances that affect gastrointestinal dysfunction, and even some patients will not solve it in time when they want to solve the stool, which will lead to constipation. Elderly people with cognitive impairment are more likely to have abnormal mental state.
prevention and management of constipation in the elderly
if the chronic constipation in the elderly cannot be effectively solved, it will bring many disadvantages to the elderly, and even the above dangers and accidents may occur. So, what should we do about chronic constipation of the elderly?
It is necessary for caregivers to know the living habits of the elderly. It may be helpful for doctors to make a diagnosis by recording the drugs used by patients, defecation, diet and fluid intake, and any other observed changes. Common treatment measures include the following contents:
1. Adequate dietary fiber intake, more than 25g per day, increase the intake of whole grains, vegetables, bacteria and algae and fruits, such as wheat bran, brown rice, fruits and vegetables (apples, oranges, celery, leeks, vegetables, etc.). Here, special attention should be paid to ensure that you drink enough water when eating high-fiber foods, otherwise high dietary fibres diet will aggravate constipation.
2. Increase drinking water and form a good habit of drinking water regularly, especially a cup of warm boiled water or honey water every morning can stimulate gastrocolon reflex and promote intestinal peristalsis. It is advisable to drink 15-17ml of water every day, 5-7ml each time. It is best to record the water consumption of the elderly, encourage them to drink more water and keep their stools moist. For the elderly who don't want to drink more water, juice and soup may be a good choice.
3. Eat more fermented foods rich in probiotics, such as yogurt and healthy intestinal flora.
4. Oil has the function of relaxing bowels, which can appropriately increase the intake of peanut oil, sesame oil or sesame seeds, sunflower seeds and walnuts with high oil content; Nuts contain a certain amount of oil, which can lubricate the intestines, and fatty acids decomposed by oil can stimulate intestinal peristalsis; (Note that oil itself is harmful to cardiovascular and cerebrovascular diseases, and it is recommended to use it in moderation).
5. Try to defecate regularly as far as possible, and establish correct defecation habits. It is recommended to try defecation in the morning or within 2 hours after meals.
6. Increase exercise and avoid sedentary, such as walking, playing Tai Ji Chuan, doing exercises, running, abdominal massage, etc. For the elderly who stay in bed for a long time, even sitting up, standing or walking around the bed is beneficial to defecation.
7. Abdominal massage: Lie on your back on the bed, with your knees bent, your left hand on your navel, your right hand on the back of your left hand, and massage clockwise around your navel, 2-3 times a day for 5-1 minutes each time.
8. drug therapy: if the above methods fail, some drugs can be used appropriately, and some powerful laxatives such as senna and rhubarb are not recommended, which may lead to electrolyte (potassium, sodium, chlorine, etc.) disorder and other toxic and side effects. You can choose some milder drugs such as Shumi capsule, lactulose, Longhui pill and Maren pill. If constipation lasts too long, you can use mechanical defecation AIDS such as glycerin enema or kaisailu. Long-term use of drugs is not recommended. Drugs for constipation will damage intestinal function. It should be noted that patients with cognitive impairment are inconvenient to move, and some of them are in bed. After using drugs, diarrhea symptoms such as loose stools and watery stools may occur. At this time, they need to be cleaned in time to keep their buttocks dry to avoid skin diseases.
5. If the elderly actively adopt the above methods, they still can't solve the distress of defecation, which may give us some dangerous signals, so we should pay attention to them.
For example, bloody stool, black stool or tarry stool, and obvious weight loss in a short time may indicate the possibility of tumor; Obvious abdominal distension, abdominal pain, nausea and vomiting may indicate intestinal obstruction; Fever greater than 37.3 C；; Poor mental health and sleeping may be caused by physical diseases. It is suggested that the elderly should actively go to the geriatrics or gastroenterology department to seek the help of doctors. (Author: Qian Shixing Jing Wong Reviewer: Li Xia)
# Health #