Constipation in the Elderly
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At least 75 percent of elderly hospitalized patients use laxatives for bowel regulation. Delay in transit time with in the colon is the most frequent non-obstructive cause of constipation.
Diet plays a critical role in bowel function, especially in the elderly. Greater amounts of crude dietary fiber are associated with a lesser prevalence of constipation. Fiber appears to increase stool bulk and weight and speeds up intestinal transit time. Several mechanisms may account for these observations:
- Fiber may act as a bulk-forming agent.
- Fiber may bind fecal bile salts, which stimulates bowel movement.
- Fiber is metabolized by colonic bacteria to non-absorbable, volatile fatty acids, which may stimulate bowel movement.
The low-fiber diet generally consumed by the elderly, along with sedentary lifestyle and poor fluid intake, may account for the large number of older patients who complain of constipation.
As an initial step in treatment, the patient should be advised to follow a diet rich in fiber. It may also be reasonable to add a fiber preparation to the high-fiber diet.
To ensure that fiber itself does not become constipating, adequate fluid intake is necessary. This is especially true in the patient who is already taking a diuretic. The recommended daily requirement for water (or non-caffeinated fluids) is 8-10 glasses, assuming that the patient has no heart or kidney problems that prohibit intake of this amount of fluid.