Constipation is a problem that we experience at every age and has a number of causes. Experts agree that old age is one of the main risk factors for constipation; thus, the incidence of constipation is significantly higher in the elderly, up to 20% in comparison to young subjects.
It is important to identify the problem and treat it without delay. It is likewise important to determine whether constipation is functional or organic – that is, determine its actual cause. We should keep in mind that constipation is not a disease, but a symptom, and that the essential thing is to eliminate the cause rather than the symptom.
Aging is a natural process that involves changes in organs, including those of the gastrointestinal tract.
Causes of constipation in the elderly
Constipation in the elderly has many possible causes. Anatomical changes in the lower gastrointestinal tract, related to aging, can contribute to slower digestion and lower water content of the stool. Neurodegenerative changes also negatively affect digestive function. Scientists have determined that at age 65 people have 37% fewer intestinal neurons in the large intestine compared to younger adults. The intestinal nerve system controls the contraction and expansion of intestinal muscles, which moves food through the digestive tract. Since it regulates the intensity and frequency of muscle contraction, it is not surprising that a decrease in the number of intestinal neurons results in decreased intestinal motility.
The reduced tone of intestinal muscles (intestinal atony) is generally held to be one of the main causes of chronic constipation in the elderly. It is brought about by physiological aging that sees a decrease in the intestinal muscle motor function. Furthermore, the anal sphincter muscle weakens, and the pelvic floor muscles also decline in strength. Some studies show that the function of pelvic floor muscles deteriorate in more than 50% of the elderly. This change is most frequent in post-menopausal women, with vaginal birth injuries regarded as one probable cause.
Along with physiological causes, there are also several clinical factors linked with constipation in old age. Older people often take medications that may cause constipation (antacids with aluminium and calcium, antidepressants, antihistamines, calcium supplements, diuretics, iron supplements, etc.) Other possible causes include common medical conditions of the elderly, such as type 2 diabetes, depression, Parkinson’s disease, dementia, hyperthyroidism, hypothyroidism, multiple sclerosis, electrolyte imbalance, and others.
Changes in eating habits or a reduced intake of food, reduced physical activity, and inadequate fluid intake also lead to this common problem.
The treatment of constipation in the elderly should be undertaken with considerable care, as they are more sensitive to its possible adverse effects. Constipation can substantially reduce their quality of life.
We should promote a balanced diet and give it precedence over other medical interventions. If diet and lifestyle changes fail to help, the next recommended step in treatment is the use of osmotic laxatives.
Osmotic laxatives are suitable for patients who do not respond to an increased intake of dietary fibre. When choosing the laxative, we should always consider the patient’s medical history, in particular heart and liver conditions, possible interactions with other medications and/or dietary supplements, and possible adverse effects.