Severe Constipation Complications in the Elderly: Gastroenterologist Explains.

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Complications of severe constipation in the elderly include:

  • Stool impaction.
  • Stool incontinence.
  • Overflow diarrhea.
  • Anal fissures.
  • Hemorrhoids (piles).
  • Others such as rectal prolapse, rectal ulcers, intestinal obstruction, or intestinal perforation.

Why are constipation (and its complications ) more common in the elderly?

The elderly are often at a higher risk of constipation and its complications.

  • Up to 70% of the elderly in nursing homes suffer from severe constipation.
  • Among that 70%, about 7% will have fecal impaction during examination (reference).

Several risk factors make constipation, and its complications are more prevalent in the elderly (reference).

Why the elderly are at higher risk of constipation:

  • The lack of physical activity.
  • General disability.
  • Low caloric intake (inadequate eating is a risk factor for severe constipation).
  • Diseases that predispose to constipation are more common in the elderly: Diabetes, chronic renal diseases, hypothyroidism, cerebrovascular diseases, parkinsonism, autonomic neuropathy, dementia, and others.
  • The elderly are more likely to take drugs that cause constipation: Analgesics, antidepressants, some anti-hypertensives, antiparkinson, iron supplements, antihistamines, diuretics, and others.

The same factors above also contribute to a higher incidence of constipation complications.

Older age is a risk for complicated constipation. The elderly are at more risk because of limited mobility, low food intake, and general disability.

1. Fecal impaction.

What is fecal impaction?

Fecal impaction is a common complication of constipation in elderly debilitated people.

Prolonged severe constipation leads to hardening of the stool. The hard stool forms a mass in the last part of the colon. The elderly with fecal impaction cannot pass the impacted mass with normal defecation.

Who are at higher risk of fecal impaction?

  • Being an elderly female.
  • Reduced physical activity.
  • Bed-ridden debilitated elderly.
  • Neurological diseases: Parkinson’s disease, spinal cord injuries, multiple sclerosis, and others.
  • Regular use of medications such as non-steroidal anti-inflammatory drugs and some anti-hypertensives.

Symptoms:

  • Prolonged severe constipation (It may last for a week or more).
  • A sense of poop mass in the rectum that is too big to come out.
  • Abdominal pain increases after meals.
  • Sometimes, the liquid stool is leaking around the impacted mass of feces (false diarrhea).
  • Recent onset anorexia (loss of appetite).
  • Progressive bloating If the elderly are aware. Visible distension is also noticeable.
  • Nausea and vomiting may also occur.
  • A sense of increased fatigue and headache.

What to do if you suspect fecal impaction?

If you suspect fecal impaction, please call your doctor or nurse. Laxatives may be ineffective for fecal impaction in the elderly.

Moreover, if you use large doses of laxatives may worsen fecal impaction. Fecal impaction in the elderly may require manual disimpaction.

Learn More: How to know fecal impaction has been cleared?

2. Stool incontinence & Overflow diarrhea.

Stool Incontinence:

Severe constipation in the elderly is often associated with damage in the muscle rings at the end of the rectum.

Prolonged constipation and recurrent straining can lead to stool incontinence due to sphincter damage.

Stool incontinence can be in the form of:

  • Inability to control stool passage before reaching the toilet (after feeling the urge to poop).
  • Soiling accidents: the passage of the stool or mucus without knowing it.

Learn more about stool incontinence.

Overflow diarrhea (a complication of stool impaction).

Severe constipation leading to stool impaction obstructs the rectum with a hard stool mass.

The stool above the mass becomes liquified and leaks from around the mass to the outside. In the elderly, overflow diarrhea is a complication of severe constipation.

The overflow diarrhea is another cause of incontinence in the elderly. The larger the poop mass, the greater is the stretch of the rectal wall.

In turn, the rectal wall stretch predisposes to the relaxation of the anal sphincter, which causes incontinence.

The symptoms of overflow diarrhea are the same as stool impaction (constant urge to poop, sense of incomplete evacuation), Plus diarrhea, or incontinence.

3. Anal fissure.

The anal canal is a short tubular structure surrounded by muscle rings. It forms the last part of your colon and digestive tract.

Severe constipation in the elderly can lead to a tear in the wall of the anal canal. Fissures are common; they typically heal within a short period.

However, anal fissures complications severe constipation in the elderly tend to become persistent.

Symptoms of anal fissures:

  • Sharp pain during a bowel movement in the anal canal.
  • Pain often starts with defecation and may last for minutes to hours.
  • Sometimes, Bright red blood in stool or toilet paper after bowel movements.
  • A small lump or skin stage in the skin near the fissure.

Constipation leads to anal fissures. Moreover, Fissure pain leads to fear of defecation, which in turn leads to more constipation.

This vicious circle may lead to severe complications in the elderly such as fecal impaction.

Detection and treatment of anal fissures are important. Elderly with painful fissures have difficult-to-treat constipation.

4. Piles (Hemorrhoids).

Prolonged constipation and straining in the elderly leads to dilation in the anus and lower rectum veins.

Severe constipation is a major risk factor for piles. In addition, hemorrhoids are widespread, especially in the elderly.

Symptoms:

  • Asymptomatic in many cases.
  • Rarely, it causes mild pain or irritation in the anal area.
  • A swelling or a skin stage around the anus.
  • Bleeding (mixed with stool or blood coming out without stool).
  • Signs of complications include dizziness, shortness of breath, fast heartbeats (symptoms of anemia from bleeding piles).
  • Hemorrhoids may become thrombosed and inflamed. This causes severe pain and swelling in the anal canal.

5. Others.

Severe constipation in the elderly may also lead to other complications. Although less frequent, the below complication can cause significant illness and disability:

  • Rectal Prolapse: over-straining leads to the protrusion of the last part of the rectum beyond the anus.
  • Complete intestinal obstruction.
  • Rectal ulcers.
  • Large bowel perforation.