What are the precautions for acute constipation in the elderly?

According to statistics, the incidence of constipation in the elderly aged 65 years or older is 5 times higher than that of younger patients, and its occurrence is closely related to the patient’s physical condition, dietary habits (including water intake and exercise), medications, electrolytes, pelvic floor function and other factors. Most elderly constipation is still functional constipation, which belongs to Chinese medicine’s deficiency constipation and Western medicine’s slow-transmission colon constipation. Once acute constipation occurs in the elderly, it can be manifested as anal swelling, pain and discomfort, or even edema of the anal verge, overflowing fecal water and other symptoms, and may also appear irritable, nervous, anxious and other emotional reactions, too violent finger buckling feces, and may even lead to anorectal rupture and bleeding. In view of the increasing number of elderly patients with constipation, it is especially important to master reasonable and effective home care methods. In fact, the occurrence of acute constipation in the elderly has a process of development and aggravation, usually that may be manifested as a small amount of defecation, poor defecation, incomplete defecation and other symptoms, at this time should pay attention to the timely and reasonable selection of the use of laxative drugs, and should not pay too much attention to the side effects of laxatives, fear of medication, should consider the principle of first pass after the reduction of medication, and at the same time, by increasing the amount of water, exercise, dietary fiber intake and other ways. gradually overcome the drug dependence. Emergency treatment: In acute constipation (fecal impaction) in the elderly, the hand picking method can be used. Gently insert the index finger into the anus and remove the dry and hard stool by pounding it into the anus (pay attention to the tolerance of the elderly). Pay attention to the smoothness of the head end and the direction of insertion before use to avoid damaging the rectal mucosa of the anal canal, first squeeze out a little liquid to lubricate the opening, then take a left lateral position, relax the anus and take a deep breath, insert the head end gently into the anus and then squeeze the liquid into the rectum with force to avoid sucking back and reduce the dosage, and tolerate until you have a bowel movement. When the treatment is finished, the rationale should be to wash around the anus with warm water to facilitate the contraction of the anal sphincter. The drug method can also be used, i.e., ton of 3600mg (6 capsules) of hempren soft capsule or 1000ml of liquid flushed by 1 packet of polyethylene glycol electrolyte bulk (68.56g), which can discharge the residual stool in about 2-4 hours. Rational use of laxative drugs: avoid using the same laxative alone for a long time to avoid forming dependence, avoid taking laxatives with stimulation, such as rhubarb, mannitol, fruit guide tablets, etc.; do not use or use less drugs that can easily cause constipation, such as codeine, iron, aluminum, calcium, etc.; be careful with sedatives that can inhibit gastrointestinal motility, anticholinergics such as atropine, belladonna, scopolamine and other drugs. As elderly patients have hypertension, heart disease and renal insufficiency to varying degrees, they should be cautious in the use of drugs. Generally, Chinese medicines are used in the form of marijuana soft capsules, Qirong Runguang or Cistanches Laxative Oral Liquid (containing honey, caution for diabetic patients), and Western medicines are used in the form of lactulose, Fosone and other drugs with less side effects and irritation. Encourage patients over 80 years old with persistent constipation to take medication for a long period of time, and promptly revise the dose or variety of medication according to the effect of medication and defecation. The main points of life care after the relief of constipation: 1, regular defecation habits to develop the habit of regular living, do not easily change the routine, guide patients regardless of the intention to defecate, defecate regularly every day, defecation to force, focus, do not listen to music, read newspapers and magazines when defecating, to develop good defecation habits; sedentary, less mobile, abdominal muscle weakness constipation, it is best to take a squatting position or if necessary, consider defecation Feet on a low stool, knee-hugging type to assist defecation, long-term bedridden is best to take a sitting position or appropriate elevated head of the bed, to increase intra-abdominal pressure to facilitate defecation. 2, reasonable diet should eat more fiber-rich foods, such as vegetables, fruits, coarse grains, etc.. Increase the amount of water, drink 1500-2000mL of water daily, drink a glass of warm water or light salt water every morning, drink warm water, lemon juice and other drinks before each meal to promote intestinal motility. Drink honey water often to facilitate bowel movement. Eat less spicy and other stimulating foods. Patients with renal insufficiency should not overemphasize the amount of water, vegetarian patients should also consider a certain intake of fat, fatty foods can make the stool silky smooth, and the fatty acids it contains can stimulate the smooth muscle of the intestines and promote intestinal peristalsis. 3., appropriate to increase the amount of activity to enhance physical fitness according to personal conditions, engage in appropriate activities, such as walking, jogging, taijiquan, etc.. Can refer to the use of exercise therapy ① massage abdomen: clockwise massage abdomen about 50 times, the number of massage can be regulated according to personal tolerance; ② abdominal exercise: deep inhalation when lying down will abdominal bulge, exhale when the abdominal contraction, about 20 times a day; ③ anal exercise: 10-20 times a night, in order to exercise the contraction force of the anal muscle. 4, timely understanding of the stool situation In general, defecation 1 to 2 times a day or once every 2-3 days, the stool is yellow-brown formed soft stool (commonly known as “banana stool”) that is normal defecation. 5, good mental state actively face life, develop a healthy lifestyle, eliminate tension factors, overcome bad emotions, reasonable arrangements for the enjoyment of life.