Constipation

About five to fifteen percent of the population are suffering from constipation – women twice as often as men. With increasing age the number of affected persons rises significantly. According to surveys conducted by the Chair for Nursing Sciences at the University Witten/Herdecke, every second person of the home residents is‑affected.

Cases, where patients have to push hard during bowel movement for a period of three or more months, the emptying is not subjectively complete or the faeces are lumpy or hard, are classified as chronic constipation. Less than three bowel movements per week can also be an indication that things are not quite right.

Constipation can occur for different reasons. Many senior citizens lack physical activity, they do not drink enough and their diet is often one-sided. Even if physical activity, fibres and sufficient fluid do not, as has been proved, get rid of constipation, it is on the other hand well known that people who do regular physical exercises rarely suffer from constipation.

In addition, senior citizens often have to take several medicaments as a permanent therapy, among these possibly drugs that can influence the gastrointestinal tract, namely antibiotics (fluorchinolone), tricyclic antidepressants (imipramine and others), anticonvulsants (gabapentin), antihypertensive agents (clonidine), calcium antagonists (verapamil), diuretics (thiazide), opiate analgesics (morphine, codeine) and iron preparations.

The environment too can contribute to constipation. Nobody likes to do his »Number two« without privacy. Old, bedridden people sharing a room with other­ old people in a care home, often have no alternative. This massive disturbance of their private sphere suffices to encourage constipation. So the only thing left are drug substances to get the bowels going again. And last but not least, years of laxative misuse will also lead to constipation. In a consul­tation, close questioning is therefore all the more important.

Questions

• Have you already been constipated more often?
• How often do you have a bowel movement and with what kind of problems?
• Do you have pains or have you noticed blood in your stool?
• Do you have a temperature?
• Has the constipation occurred suddenly?
• Do you suffer from diabetes or any thyroid disorder?
• Have you changed your diet?
• Has there been any change in your movement behaviour?
• Have you already taken a laxative?

Information

• It can help your digestion if you eat a lot of vegetables and fruit, drink sufficiently and do physical exercises daily.
• In the case of slight constipation, swelling agents will ensure a regulated bowel movement. If you take swelling agents such as psyllium husks, you must drink a large glass of water with it.
• After having used a swelling agent, you need to wait for at least half an hour before taking any other medication.
• Macrogol, bisacodyl, sodium picosulphate and lactulose are laxatives. Ask your doctor how long you should take these initially.
• There are also prescription medicines for constipation. They are used if any other remedies will not help.

Additional information

• Take your time when you are at the toilet, as here the psyche plays an important role.
• People in a care home do not always have the necessary privacy for going to the toilet. As a relative you should ask about this point in the care home.
• Optimize your diet or that of a relative­ being cared for. Here it would be better to do without food items such as chocolate, bananas or white bread that tend to constipate.
• In consultation with the nursing staff, try to mobilise the relative being cared for to do physical exercise.