Constipations in elderly: diagnostics and treatment approach
Abstract
The aim of review. To illuminate principal causes and features of manifestations of constipation at elderly patients, to present a general investigation and treat- ment plan.
Original positions. In economically developed countries about one third of population over 65 years of age has constipation. One of the vital issues related to it, is decrease of quality of life and social activity of patients. The basic role in intestinal function disorders is played not so much by age-related changes of gastro-intestinal tract, but rather by systemic back- ground disease, characteristic for persons of the senior age. In some cases functional constipation is present. At investigation of the patient it is especially important to estimate history of drug intake, to pay the special attention to signs of obscure depression and anxiety, systemic and neurologic diseases and so- called «red flags». Constipation with delayed transit and megarectum are associated to the risk of fecal impaction, compression of urinary tract and stercoral colitis development, with intestinal perforation, blee- ding and suppuration.
At treatment prescription it is necessary to take into account nature of constipation, features of clini- cal pattern, intestinal transit, incidental or persistent course. Adequate nutrition, physical motions, treat- ment of cognitive disorders and care for the patient have major value. Algorithms of stage-by-stage treat- ment of constipation with normal and delayed transit are presented.
Conclusion. Disorder of emptying of intestine in elderly age is a common problem which can significantly aggravate general state of the patient and sometimes result in lethal complications. Medical staff should pay special attention to evaluation of intestinal functions and comprehend stage-by-stage constipation treatment.
References
1. Пасечников В.Д. Функциональный запор, обусловленный замедленным транзитом кишечного содержимого // Фарматека. – 2003. – № 10. – С. 16–23.
2. Рак толстой кишки. – http://www.endocentre.ru/17_z.html (2010, 4 апр.)
3. An H.M., Baek E.H., Jang S. et al. Efficacy of Lactic Acid Bacteria (LAB) supplement in management of constipation among nursing home residents // Nutr. J. – 2010. – Vol. 5, N 9. – P. 5.
4. Beers M.H., ed. The Merck Manual of Geriatrics. Copyright © 2009–2010 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.
5. Chiu C.M., Wang C.P., Sung W.H. et al. Functional magnetic stimulation in constipation associated with Parkinson’s disease // J. Rehabil. Med. – 2009. – Vol. 41, N 13. – P. 1085–1089.
6. Cid A.A., Pietruk T., Bidari C.Z., Ehrinpreis M.N. Cecal fecaloma mimicking colonic neoplasm // Dig. Dis. Sci. – 1981. – Vol. 26, N 12. – P. 1134–1137.
7. Di Palma J.A., Halpert А. Guideline 2008. Managing: Chronic Constipation. Version 1.0. International Gudelines Center. – www.guidelines@GuidelinesCenter.com
8. Edden Y., Shih S.S., Wexner S.D. Solitary rectal ulcer syndrome and stercoral ulcers // Gastroenterol. Clin. North Am. – 2009. – Vol. 38, N 3. – P. 541–545.
9. Evans J.M., Fleming K.C., Talley N.J. et al. Relation of colonic transit to functional bowel disease in older people: a population-based study // J. Am. Geriatr. Soc. – 1998. – Vol. 46, N 1. – P. 83–87.
10. Gau J., Acharya U., Marx T. et al. Megacolon and stercoral proctitis after frequent fecal impactions: Report of an unusual case and review of the literature // J. Am. Med. Directors Assoc. – 2007. –Vol. 8, N 5. – P. 338–341.
11. Geramizadeh B., Hayati K., Rahsaz M., Hosseini S.V. Assessing the interstitial cells of Cajal, cells of enteric nervous system and neurotransmitters in slow transit constipation, using immunohistochemistry for CD117, PGP9.5 and serotonin // Hepatogastroenterology. – 2009. – Vol. 56, N 96. – P. 1670–1674.
12. Glia A., Lindberg G. Quality of life in patients with different types of functional constipation // Scand. J. Gastroenterol. – 1997. – Vol. 32. – P. 1083–1089.
13. Hamid S.A., Di Lorenzo C., Reddy S.N. et al. Bisacodyl and high-amplitude-propagating colonic contractions in children // J. Pediatr. Gastroenterol. Nutr. – 1998. – Vol. 27, N 4. – P. 398–402.
14. Harari D., Gurwitz J.H., Minaker K.L. Constipation in the elderly // J. Am. Geriatr. Soc. – 1993. – Vol. 41. – P. 130–140.
15. Heffernan C., Pachter H.L., Megibow A.J., Macari M. Stercoral colitis leading to fatal peritonitis: CT findings // AJR. – 2005. – Vol. 184. – P. 1189–1193.
16. Holson D.A. Constipation. – http://emedicine.medscape. com/article/774726 (2010, 4 апр.). 17. Hsieh C. Treatment of constipation in older adults // Am. Fam. Physician. – 2005. – Vol. 72, N 11. – P. 2277–2284.
17. Joung H., Han K., Cho M. et al. Clinical outcomes of stercoral colitis: single center experience in South Korea // Gastro. – 2009. – UEGW/WCOG, Abstract. – P. 1713.
18. Kienzle-Horn S., Vix J.M., Schuijt C. et al. Comparison of bisacodyl and sodium picosulphate in the treatment of chronic constipation // Curr. Med. Res. Opin. – 2007. – Vol. 23, N 4. – P. 691–699.
19. Kienzle-Horn S., Vix J.M., Schuijt C. et al. Efficacy and safety of bisacodyl in the acute treatment of constipation: a double-blind, randomized, placebo-controlled study // Aliment. Pharmacol. Ther. – 2006. – Vol. 23, N 10. – P. 1479–1488.
20. Knobel B., Rosman P., Gewurtz G. Bilateral hydronephrosis due to fecaloma in an elderly woman // J. Clin. Gastroenterol. – 2000. – Vol. 30, N 3. – P. 311–313.
21. Koch T., Hoffmeyer A., Hudson S. Exploring constipation and prescribed and over the counter laxative use among older adults. Royal district nursing service research unit: Adelaide, 1998. – P. 1–6.
22. Lewis S.J., Heaton K.W. The metabolic consequences of slow colonic transit // Am. J. Gastroenterol. – 1999. – Vol. 94. – P. 2010–2016.
23. Madiba T.E., Thompson S.R. The management of sigmoid volvulus // J. R. Coll. Surg. Edinb. – 2000. – Vol. 45. – P. 74-80.
24. Manabe N., Cremonini F., Camilleri M. et al. Effects of bisacodyl on ascending colon emptying and overall colonic transit in healthy volunteers // Aliment. Pharmacol. Ther. – 2009. – Vol. 30, N 9. – P. 930–936.
25. MeLennan W., Podger A. 1995 National nutrition survey // Selected highlights. – Canberra: Australian Bureau of Statistics, 1997. – P. 17.
26. Nicolas A.S., Faisant C., Nourhashemi F. et al. The nutritional intake of a free-living healthy French population: a four-year follow-up // J. Nutr. Health Aging. – 2000. – Vol. 4. – P. 77–80.
27. Norton C., Chelvanayagam S. Bowel problems and coping strategies in people with multiple sclerosis // Br. J. Nurs. – 2010. – Vol. 19, N 4. – P. 220–226.
28. Ostaszkiewicz J., Hornby L., Millar L., Ockerby C. The effects of conservative treatment for constipation on symptom severity and quality of life in community-dwelling adults // J. Wound Ostomy Continence Nurs. – 2010. – Vol. 37, N 2. – P. 193–198.
29. Qasabian R., Meagher A., Lee R. et al. Severe diverticulitis after heart, lung, and heart–lung transplantation // J. Heart Lung Transplant. – Vol. 23, N 7. – P. 845–849.
30. Remes-Troche J.M. Constipation: Initial evaluation and diagnostic approach // Rev. Gastroenterol. Mex. – 2005. – Vol. 70, N 3. – P. 312–322.
31. Schaefer D.C., Cheskin L.J. Constipation in the elderly // Am. Fam. Physician. – 1998. – Vol. 58, N 4. – P. 907–914.
32. Stoll R.E., Blanchard K.T., Stoltz J.H. et al. Phenolphthalein and bisacodyl: assessment of genotoxic and carcinogenic responses in heterozygous p53 (+/-) mice and syrian hamster embryo (SHE) assay // Toxicol. Sci.– 2006. – Vol. 90, N 2. – P. 440–450.
33. Sturtzel B., Dietrich A., Wagner K.H. et al. The status of vitamins B6, B12, folate, and of homocysteine in geriatric home residents receiving laxatives or dietary fiber // J. Nutr. Health Aging. – 2010. – Vol. 14, N 3. – P. 219–223.
34. Suttor V.P., Prott G.M., Hansen R.D. et al. Evidence for pelvic floor dyssynergia in patients with irritable bowel syndrome // Dis. Colon Rectum. – 2010. – Vol. 53, N 2. – P. 156–160.
35. Talley N.J. Constipation and diet in a community sample of older Australians (Original Research) // Nutrition & Dietetics: The Journal Dietitians Association Australia. December 1, 2002.
36. Triantafyllou K., Vlachogiannakos J., Ladas S.D. Gastrointestinal and liver side effects of drugs in elderly patients // Best Pract. Res. Clin. Gastroenterol. – 2010. – Vol. 24, N 2. – P. 203–215.
37. Wiriyakosol S., Kongdan Y., Euanorasetr C. et al. Randomized controlled trial of bisacodyl suppository versus placebo for postoperative ileus after elective colectomy for colon cancer // Asian J. Surg. – 2007. – Vol. 30, N 3. – P. 167–172.
38. Zhu L., Lang J., Liu C. et al. Epidemiological study of urge urinary incontinence and risk factors in China // Int. Urgynecol. J. Pelvic Floor Dysfunct. – 2010. – Vol. 21, N 5. – P. 589–593.
39. Zingg U., Miskovic D., Pasternak I. et al. Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial // Int. J. Colorectal Dis. – 2008. – Vol. 23, N 12. – P. 1175–1183.
Review
For citations:
Shulpekova Yu.O. Constipations in elderly: diagnostics and treatment approach. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2011;21(2):69-75. (In Russ.)
Views:
68
Email this article 
