Constipation after 65 years: Do not do anything
Disorders of the intestinal transit are especially frequent after 65 years. Indeed, beyond this age, more than one person in two complains about constipation. Alas, the diagnosis is not always easy to establish and is sometimes opposed to the perception of each. Here is a small reminder of definitions and practical advice, to better fight this embarrassment.
How do you know if you are constipated?
“Doctor, I am constipated …”. This sentence sets forth a reality, which physicians sometimes have difficulty questioning, so strong is the conviction of the person who formulates it. However, a slowing of the intestinal transit is not necessarily sufficient to make the diagnosis of functional constipation. At least 2 of the following four symptoms have been observed for at least 12 months:
- Less than two stools per week;
- Hard stools at least one times out of 4;
- Pushing force at least one time out of 4;
- The sensation of “not having eliminated everything” at least once in 4.
Why does this problem increase with age?
Normal aging affects all functions of the body. However, the intestinal transit does not slow down with age. What decreases is the musculature in general and especially that which is in the perineum, making the effort of exemption more painful? In fact, it is the general, chronic diseases that are the biggest risk factors for constipation. By very distinct but well-known mechanisms, conditions such as diabetes, malfunctioning of the thyroid gland, kidney failure, Parkinson’s disease, cerebrovascular disease, depression, etc., may result from Constipation. The risk increases when diseases accumulate,
When should additional tests be performed?
In most cases, the examination and a full clinical examination are sufficient for proper management. However, sometimes it will be necessary to shed light on the origin of constipation, in particular:
- When the phenomenon is recent, associated with weight loss, anemia, abdominal pain, loss of blood in the stool or a family history of digestive cancer;
- When we notice a recent change in a very old constipation
- In the case of ineffectiveness of a perfectly adapted and followed treatment;
- When incontinence or diarrhea occurs (which can be caused paradoxically by a large rectum size).
What drugs are useful?
Once the dangerous lifestyle and favorable factors are corrected (see tips below), laxatives can be proposed. However, when you are senior, be careful not to take anything! The osmotic laxatives (lactulose, lactitol, PEG) are products well adapted to the great age. They can be taken daily and over the course. On the other hand, it is better to avoid the lubricants (oil of paraffin), often responsible for accidents very annoying (itching, “leaks”). The use of so-called irritant laxatives can help, provided that their use is only punctual. Indeed, their use over too extended periods is at the origin of the painful “disease of the laxatives,” causing among others chronic colic pains.
Watch out for drugs that “constipate.”
Some pain medications (morphine, codeine, anti-inflammatory drugs), depression or behavioral disorders (tricyclic antidepressants, neuroleptics), heart failure (calcium channel blockers, diuretics) or Parkinson’s disease are well known for their Constipating effect.
Some practical tips for not forgetting the right reflexes
- Moving: the role of physical activity on transit is controversial. It is recognized, however, that sedentary lifestyle, and a fortiori lying down, diminish colonic drive. A daily walk, as long as possible, is therefore highly recommendable.
- Eating well: the decrease in appetite often accompanies old age. Similarly, decreased intake of dietary fiber due to poor tolerance (bloating) is a factor promoting constipation. Eating natural fruits and vegetables is already a good habit to keep (or to take back!).
- Never let the need pass: you have to go to the saddle when you want. Afterward, it is often too late.
- Go to the washroom at a fixed time. The regular use of micro evacuating enemas may be a solution to maintain a certain rhythm.
- Drinking or not drinking? If a large glass of fresh water in the morning promotes the triggering of the need, the abundant intake of liquid during the day has not proven its effectiveness on constipation. That said, age dulls the sensation of thirst, so it is no worse to have to drink during the day (not more than a liter and a half) to facilitate the work of the kidney.
- Do not hesitate to get help, even daily, with laxatives, provided you follow the doctor’s recommendations. However, beware of homemade “cocktails” with the latest over-the-counter miracle treatments! Self-medication is to be avoided, even for a matter as commonplace as constipation.