Constipation in the elderly

Most of the causes of constipation in younger age groups apply to the elderly and I will not attempt a systematic classification (Table When bowels have not acted for some days after illness relatives will say 'But she hasn't eaten anything'and they are right. Lack of food whether from starvation or illness may be a cause, especially if food is easily absorbed and lacking in insoluble cellulose residues or roughage. Lack of sufficient fluids may also cause constipation. This may be due to sweat loss in fever or hot weather, loss by vomiting, or diuresis for instance in diabetes, causing dehydration. A helpless old person can easily become dehydrated even with ample fluid on the locker, simply because nursing staff do not ensure that it is taken. Even if given fre- quently, much is often spilt and little swallowed. Sometimes the elderly, who have small capacity bladders and suffer frequency of micturition, habitually take insufficient fluid for fear of incon- tinence or the need to make frequent visits to the toilet. With old kidneys passing urine of fixed low concentration the risk of dehydration is the greater. TABLE 1 Some causes of constipation in the elderly Lack of physiological needs Muscular weakness, herniae Bowel abnormalities Neglect of call to stool Drugs Food Cellulose residues Fluids Thyroid Diaphragm Abdominal wall Pelvic floor Bv ,vel musculature Carcinoma Diverticulitis Discomfort of toilet Fear of pain-piles, fissure Vascular brain damage Depression Purgatives Iron Codeine Antacids-calcium carbonate Anti-spasmodics Anti-hypertensives Anti-Parkinsonism drugs Barbiturates, sedatives