Constipation care for seniors

On 06 Jan 2024, Seniors Today hosted their weekly Health Live Webinar with a Senior Physician, Dr Rajesh Jaria who spoke on and answered questions about Constipation Care for Seniors.

Dr Rajesh Jaria has been managing Intensive Care since 1999. Having had more than his fair share of ICU rotations at JJ Group of hospitals, he further honed his skills at Singapore and later worked as an Intensivist in Mumbai where he set up a Liver Transplant ICU. He has been closely associated with the Cardiac Surgery team and has handled post CABG / Cardiac surgeries at key hospitals in Mumbai city. He has a special interest in Diabetology and Endocrinology.

The current covid situation is not a cause for concern as not a lot of patients are coming/ reporting to the hospital with severe symptoms, says Dr Rajesh Jarai on the present covid state. As on date, there are only 760 patients across India. Masking is not necessary but is advised to the at risk/ high risk groups, he adds. This virus does not want to increase its virulence, just its infectivity. And has thus become like any other flu / cold virus.

Constipation is a common condition with many widespread notions with no basis. The purpose of this week’s webinar is to explore current scientific knowledge on the subject, connect that knowledge with daily life and summarise the lifestyle modifications which may be needed.

Constipation is essentially can be

1. Acute- occurs suddenly, where in the symptoms present in short span of time and needs to be treated at the earliest or else it can lead to significant discomfort

Acute constipation is now a redundant term, because if it is acute in nature, it is not constipation.

1. Chronic- constipation by its definition is chronic. Chronic constipation also goes by other terms such as irregularity, bowel sluggishness, intestinal hypomotility.

The treatment of constipation includes bowel movement inducing medications and procedures.

10-20% of the general population is suffering from constipation.

Constipation affects your quality of life by affecting your vitality, daily functioning, physical roles, emotional state, it can also give you bodily pain.

The magnitude of the negative impact of constipation is similar to that of an individual with allergies, inflammatory bowel disease, etc.

Constipation is a symptom and not a diagnosis in its own right

Constipation has significant adverse effects on the quality of the patients’ life and their ability to function normally.

By definition, constipation is a constellation of symptoms-

• Fewer than 3 bowel movements in a week
• Feeling of fullness
• Need to strain in order to have a bowel movement

There is no minimum stool frequency required for health. There is an apparent dichotomy- it all depends on the patient and his comfort and complaints

Only 1/4th of patients have fewer than 3 bowel movements per week.

Some worry that their stool frequency is too low. That the longer the waste stays inside them, it is poisonous, there is obviously no basis to this theory.

For most patients the chief complaint is either the feeling of fullness or a need to strain in order to have a real bowel movement.

Sometimes the above mentioned complaints may be present without necessarily being accompanied by decrease in the frequency of bowel movements, or even an underlying pathology. It can sometimes be just psychological.

The diagnosis of constipation is made by the Rome Criteria, where in 2 of the under mentioned symptoms should be present for at least 3 of the past 6 months (making it chronic in nature) to be diagnosed as case of constipation:

1. Straining of stool for at least 1/4th of the time the patient passes stools
2. Hard stool at least 25% of the times
3. Feeling of incomplete evacuation at least 1/4th of the time
4. Feeling of anal blockage 1/4th of the time
5. Manual manoeuvres for rectal emptying at least 1/4th of the time
6. 2 stools or less per week

The presence of the last 4 symptoms also indicated impairment in defecation.

Constipation can be because of colonic issues, defecation issues.

Straining while passing stools and hard, lumpy stools are bothersome symptoms.

Rome Diagnostic Criteria for functional constipation include

1. Loose stools are rarely present without the use of laxatives
2. Insufficient criteria for irritable bowel syndrome
3. Abdominal pain and bloating may be present but it is not predominant

Physiology of defecation and normal colonic motility includes 3 types of activities/ movements that occur in the gut:

1. Segmental activity- different parts of the gut, at the same time may contract and may cause a certain amount of movement of whatever is inside to propel the contents of the bowel, towards the exit. These are short time movements but they occur frequently
2. Low amplitude propagating contractions- their main function is to move the liquid contents within the colon. They are also associated with distention during the passage of flatus.
3. High amplitude propagating contractions- strongly associated with defecation itself. Gives the feeling of passage of stools.

It is all these movements that help in the movement of food and passage of stools.

Control of defecation is mostly subconscious. There is conscious control also involved. In the morning, when you feel like going to the toilet, most of the time, the point at which you feel like going to the toilet is subconscious. Thereafter when you find the appropriate time and place to go is under conscious control.

Awareness of the urge to defecate results from the stimulation of stretch receptors.

Contraction of the rectal musculature and relaxation of the anal sphincter results in local reflexes and prepares for propulsion of faeces.

Squatting is a better position to pass stools with less strain. It is easier to pass stools in a squatting position making defecation more effective.

Lazy bowel syndrome also known as Slow Transit Constipation is characterised by slow movement in the digestive system with reduced motility of the large intestine. It is a type of functional constipation without a clear cause. Unhealthy bowel habits can lead to lazy bowel syndrome. Eating disorders can also lead to the same.

Iron preparation can cause constipation.

Diet improves gut health and it can also improve gut mucus. This can be done by:

• Increasing recipes with MACs (Microbiota Accessible Carbohydrates)- this is increased by foods such as mushrooms, zucchini, spaghetti, sprouted lentils, vegetables with tomatoes and cucumber.
• Foods that produce SCFA (Short Chain Fatty Acids)- done by consuming high fibre diets and foods, along with fermented foods such as cheese, pickles, yogurt. They also improve your cardiac health and diabetic health
• Lentils, millets

Avoid foods rich in fats, sugars, emulsifiers- these cause enhanced mucus degradation.