Disadvantages of constipation in older adults

Causes of constipation
Clinical diagnosis detects symptoms like partial dismissal of fecal matter or struggles to process feces, to term constipation in patients. However, other symptoms like intestinal bloating, dilatation, abdominal distress, and hard feces are also significant in a constipated patient. Thus, idiopathic constipation is a result of various factors.

Functional constipation has three subtypes, normal transit constipation, slow transit constipation, and defecation disorders (dys-synergic defecation). Dyssynergic defecation is a state that affects the pelvic floor muscles making the bowel movements burdensome. This condition is peculiarly frequent in older patients. The predominant causes of abnormal transportation of feces are still not known. However, several aspects might contribute to the above condition.

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1) The collagen fibers are greatly reduced in size and more firmly packed in the colon with increasing age.

2) The total quantity of myenteric plexus neurons gradually decreases with age influencing the anatomy of the colon.

3) Decreased movability slows down the digestion process.

4) Low fiber intake decreases the weight and size of feces and hardens it, making it unsuitable for passing.

5) Limited fluid intake causes the large intestine to absorb water from food waste, thus making the fecal matter hard.

Peripheral causes of constipation include:

1) Medications are calcium-channel invaders, antidiarrheal agents, opioid analgesics, and oral iron supplements.

2) Metabolic abnormalities are stroke, hypothyroidism, Parkinson’s disease, colorectal carcinoma, and hypercalcemia.

Pathophysiology of constipation
Two physiological mechanisms describe the pathway of digested food waste and its consequences leading to constipation. The first mechanism is dysmotility in the gastrointestinal tract. This condition cannot coordinate the colon’s motor activity properly, thus leading to dysfunction in removing fecal matter from the body. The second mechanism is a dysfunction in the anorectal region. For example, the distorted pelvic floor causes trouble in outlet functioning and fails to eliminate rectal constituents cautiously. However, both mechanisms can exist together in some patients.

Dysmotility in the gastrointestinal tract may occur during the following:

1) The condition occurs in inadequately prolonged transit time in the colon to transport the feces.

2) Irregular functioning of neurotransmitters in the body can cause distortions in the endocrine system that may contribute to this condition.

3) Abnormalities associated with gut hormones like somatostatin, cholecystokinin, enteroglucagon, and pancreatic peptides also contribute to colonic myopathy.

4) Prescribed medications for systemic diseases like endocrine disorders or neuronal abnormalities and improper dietary supplements also alter motility.

Improper functioning of anorectal regions shows the following clinical impacts:

1) Distorted anal sphincters or pelvic floor muscles result in anismus.

2) Immobile perineum in constipated patients causes impaired balloon expulsion, abnormality in the anorectal angle.

3) The pelvic floor descends abnormally and causes dysfunction in defecation.

4) It also results in prolonged rectosigmoid transit times.

5) Patients experience decreased pressure in the rectum and increased pressure in anal residues.

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