Constipation can be a frustrating and debilitating concern for the elderly. It can limit one’s social life, professional life, and affect one’s emotion. Of most concern is the medical complications it can cause, such as faecal impaction, exacerbating urinary tract infections, proctitis, anal fissures and haemorrhoids.
The main stay of constipation has been laxatives. The rational use of laxatives is vital to achieve successful results when used and to minimise cost to the patient. MedRN has launched its ONE MINUTE LAXATIVE chart to support nursing staff in the selection of laxatives so that optimal results can be achieved.
Whilst laxatives are one part of the treatment plan, there are other areas such as diet, lifestyle, medicines, exercise, mobility, chronic conditions which must also be assessed and considered. Non-pharmacological approaches are as equally beneficial.
Constipation in the bedfast patient can become distressing for the patient if they are experiencing difficulty voiding. The following tips are for especially the elderly patient and patients with compromised mobility.
1. An upright position is recommended for the person who is defecating. If patients are not able to sit up, a left-sidelying position is recommended. This puts pressure on the transverse colon and into the descending colon facilitating faeces movement (Sharkey & Hanlon, 1989).
2. Place a footstool in front of the toilet or beside the commode. The rationale for this is that sitting with the legs elevated on a stool in front aids the movement of the faeces into the anal canal. This is commonly seen in patients with Parkinson’s disease who suffer dysfunction of the pelvic floor muscles.
3. Gently manually push the legs toward the abdomen in bed-bound patients to stimulate a squatting position. This facilitates the use of abdominal pelvic floor muscles to help with defecation (Harari et al., 1993; Leslie,1990; Waldrop & Doughty, 2000). In the elderly, a decreased abdominal muscle strength will increase the difficulty of expelling faeces.