In the elderly, constipation is afrequently reported bowel symptom. Constipation can be defined as infrequentbowel movements, hard stools, or a feeling of incomplete evacuation (Bharucha,Dorn, Lembo, 2013). The elderly who live at home have a reported prevalence ofup to 50%, and those that are nursing home residents have prevalence up to 70%(Bazzoli, Chiarioni, & Eusebi et.
al, 2015). Constipation can be the resultof decreased mobility, medications, or underlying diseases. For these individuals,the constipation has an impact on their quality of life and can lead to morecomplicated health consequences. There are several treatment options includingdiet and lifestyle modification, stimulant laxatives, and enemas/suppositories. Diet and lifestyle affects one’sgastrointestinal motility. Studies have shown that constipation is associatedwith low intake of fiber and liquids and a sedentary lifestyle. Healthcareproviders should discuss management strategies such as increased exercise andhigh fiber diets.
Increasing fiber intake through food over fiber supplementswould be ideal. Fiber supplements can sometimes worsen symptoms in some typesof constipation (Costilla & Foxx-Orenstein, 2014). Most healthy Americansconsume less than half of the recommended daily intake of fiber (20– 35 g/day). Increased dietary fiber intake can result in decreased colonic transittimes and increased stool bulk, and should be used as a first-line treatment ofpatients with chronic constipation (Foxx-Orenstein,Gallegos, Sterler, et.al, 2011). Top sources of fiber include beans,whole grains, brown rice, vegetables, and nuts.
Depending on the mobilitystatus of the elderly individual, most exercise regimes would be hard toaccomplish. For those that are able to participate in low intensity exercise;such as, walking, weights, and stretching, it would be beneficial to theirbowel regimen. Another treatment option forconstipation in the elderly is enemas/suppositories. The use of enemas andsuppositories are best for patients who are unable to tolerate an oraltreatment option or if there is an obvious fecal impaction.
Enemas work byintroducing fluid into the intestines through the rectum which results in abowel movement (EverydayHealth, 2018). There are various enema and suppositoryoptions available. Due to the risk of electrolyte disturbances, phosphateenemas should be avoided in the elderly. The better option for this populationis plain warm water enemas (Mounsey, Raleigh, & Wilson, 2015). Suppositories,an example of a hyperosmotic laxative, are another method of relievingconstipation. It is inserted into the rectum, held together by the buttocks fora few seconds, and results in a bowel movement within 15-60 minutes (Safe Medication,2017). Stimulant laxatives are anotheroption for elderly individuals experiencing constipation. Stimulant laxativeswork by promoting intestinal motility and increasing fluid secretion into thebowel (Mounsey, Raleigh, & Wilson, 2015).
This option should only beinitiated after fiber supplementation and osmotic laxative treatments fail.Examples of stimulant laxatives are Senna and Bisacodyl (Dulcolax) and aretaken orally daily or as needed. Some reported side effects of stimulantlaxatives are abdominal pain, electrolyte imbalances, or allergic reactions (Bankhead,2013). Long term use is discouraged because it can decrease efficacy over time. Chronic constipation is common inthe elderly population. In deciding on a treatment approach, the healthcareprovider must be certain to address all other co-morbid conditions.
Healthcareproviders should educate their elderly patients about the wide range of optionsto improve their bowel health, as well as the risk factors associated withchronic constipation. If there is no improvement after all treatment optionshave been attempted, further diagnostic studies would be indicated to determinethe cause.