Treatment of constipation in the elderly food and drug selection
1 Increasing intestinal volume (bulking agent) Chen Zetao, Department of Health Care, Affiliated Hospital of Shandong University of Traditional Chinese Medicine
1.1 Increasing dietary intake
For patients with functional constipation, studies have shown that the prevalence of constipation is higher in elderly people who drink < 500
ml/ d has been shown to have a high prevalence of constipation in the elderly [3]. It has been reported that the gastrocolonic reflex is related to the amount of food eaten, and that a 1000 cal diet stimulates colonic motility, while a 350 cal diet does not.
1.2 Dietary fiber
Hu Minjuan et al. concluded that the incidence of constipation in the elderly was significantly reduced by eating high-fiber foods [4], and Luo Xiuhua et al. observed that a dietary regimen developed by the attending physician and dietitian from the perspective of the patient’s condition, nutrition, and common causes of constipation was significantly effective in improving constipation in the elderly [5]. Nutritional studies have proved that dietary fiber can directly enter the large intestine, stimulate and promote intestinal peristalsis, and make the stool easy to pass. Dietary fiber, also known as dietary fiber, is a carbohydrate contained in plant foods that cannot be decomposed and utilized by human digestive enzymes, including cellulose, hemicellulose, gum, pectin, lignin and other substances. High fiber content of food mainly exists in fresh vegetables and cereals, pectin in fruits and cellulose with the same work. Among the vegetables, garlic sprouts, celery, leeks, spinach, dried bamboo shoots, yucca slices, and mung bean sprouts, and among the cereals, corn, rice, sorghum, oats, buckwheat, maize, and millet are high in fiber. sullivan’s study showed that insoluble dietary fiber derived from fruits, vegetables, and cereals can be used in the treatment of constipation and drugs containing polysaccharides or cellulose derivatives [6]. It is recommended that a daily intake of 25-30 g of dietary fiber is preferable. In addition, coarse and fine combinations, using the complementary effect of proteins, can improve the nutritional value, promote intestinal peristalsis, and facilitate laxation. Excessive intake of dietary fiber can also cause autonomic dysfunction has the side effects of diarrhea, abdominal distension, intestinal fecal stone obstruction, affecting the absorption of vitamins and trace elements, especially for the elderly, special attention should be paid to the appropriate amount.
1.3 Volumetric drug selection
The drug choices are psyllium and methylcellulose [7]. Plantago ovata hydrophilic mucilage is a natural plant fiber extracted from the shell of Plantago ovata, hydrophilic, with better efficacy and safety. Modern pharmacology suggests that fatty sea increases volume by increasing intestinal volume and has a mechanical stimulating effect to slow diarrhea.
2 Increase intestinal osmotic pressure
Add konjac in the diet, can absorb water, increase the water content of stool, shorten the time of food in the intestinal tract and defecation time, while increasing the number of intestinal bifidobacteria, facilitate defecation. Lactulose or polyethylene glycol, which is a non-absorbable sugar, can form a hyperosmotic state in the intestinal lumen and stimulate the intestinal tract to play a laxative role. The starting dose of oral lactulose solution for constipation in the elderly is 15-30m l/ d [8]. Then the total effective rate was 93. 7%. Lactulose is a sugar-based laxative, which decomposes into small molecules of organic acids after entering the colon, which can increase the water in the stool and prevent the stool from becoming too dry and hard. White combination, compound magnesium sulfate is a magnesium salt laxative, its main component is magnesium sulfate, with the effect of increasing the water in the stool and stimulating the contraction of the intestinal wall. Osmotic laxative is suitable for medium and heavy constipation patients, but it can only be used for a short period of time, otherwise it will cause water-electrolyte disorders and hypomagnesemia.
3 lubricating substances
Diet to increase the intake of high-fat food, walnuts, pine nuts, black sesame is rich in oil, modern medical research has confirmed that the fat contained in such nuts, unsaturated fatty acids that help remove cholesterol, can lubricate the intestinal tract and laxative, traditional medicine that the kidney meridian, by nourishing the kidneys to produce fluid and moisten dryness, relieve constipation symptoms. Wood fungus, silver fungus, sea cucumber lubricating food can treat blood deficiency intestinal agitation and functional constipation in the elderly, and non-diabetic patients are instructed to drink honey water regularly for better laxative effect. Glycerin, liquid paraffin, and open cork are effective, but long-term application of lubricating laxatives can lead to malabsorption of fat-soluble vitamins. Chinese doctors use hemp seeds, cassia seeds, aconite, etc. to nourish Yin, nourish blood and moisten the intestines, and Lu Yongchang uses nourishing kidney and moistening intestines to pass through the pylorus soup to treat constipation in the elderly with the intention of increasing the water flow. Chinese patent medicine common hemp seeds Ren pill. In the “Ren Zhai Zhi Zhi Fang”, it is introduced that: to treat constipation in the elderly with weak stools, Agaricus biloba, three slices of white onion with roots, two spoons of honey, decocted in water, remove the onion, dissolve Agaricus biloba and honey, take warm before eating. This method is suitable for weak and constipated people.
4 Gas-producing substances
Eat gas-producing vegetables such as potatoes, radish, onions, soybeans, and raw cucumbers in moderation. The herb “Daily Use” says that radish broadens the chest and facilitates bowel movements. Chinese herbs such as orange peel, lycopodium, lycopodium
The Chinese herbs orange peel, lycopodium, houpo, aromatic herb and betel nut are suitable for people with constipation. They are suitable for those who are constipated and cannot pass stool, or even have abdominal distension and pain and chest fullness. Mulberry, Ocimum sanctum and incense are used to regulate the smooth flow of qi, and Chinese medicine practitioners often use Liu Mo Tang to regulate the constipation of abdominal qi.
5 Promote gastrointestinal power
B vitamin food can promote the secretion of digestive juices, maintain and promote intestinal motility, yeast, coarse grains, legumes and their products are rich in content. Among them, thiamine pyrophosphate (vitB1) is effective in increasing intestinal motility [9]. The main laxatives of this class include cisapride (Prebios), mosapride (Gastrodin), domperidone (morpholine), etc. Their action is characterized by their ability to act on intestinal nerve endings, release motor neurotransmitters or act directly on the smooth muscle of the gastrointestinal tract, increase gastrointestinal motility, promote intestinal peristalsis, and help patients with constipation to produce bowel movements. Gastrointestinal motility drugs are suitable for constipated patients with poor gastrointestinal motility. TCM Qi tonics such as Astragalus soup and Ginseng and Astragalus porridge also have the same effect. Jin Kui Kidney Qi Pill enhances the power of gastrointestinal motility by tonifying kidney energy.
6 Micro-ecological preparations
A foreign study showed that for elderly patients with chronic constipation, this type of drug can be used as an adjunct to improve intestinal flora. Therefore, it is also used as a functional probiotic to improve human health helps prevent constipation [10]. Drinking more yogurt has also been shown to improve constipation, while the opposite is true for milk.
7 Stimulant laxatives
They can be classified as anthraquinones, polyphenols, castor oil, deoxycholic acid, etc. The Chinese chronic constipation treatment guidelines suggest that the selection of laxative drugs should take into account the safety of efficacy, drug dependence and price, and the long-term use of stimulant laxatives should be avoided. The occurrence of colonic melanosis is related to the abuse of anthraquinones in high doses [11], and the pathogenic effects of anthraquinone laxatives have reached an international consensus.
The pathogenic effects of anthraquinone laxatives have been internationally recognized, such as the commonly used herbal laxatives, such as rhubarb, aloe vera, senna, cassia, etc., and the Chinese patent medicines, such as niuhuang detoxification tablets, laxative, compound aloe vera capsules, jixie conduction pills, xinqingning tablets, choling tablets, hempren rundown pills, and even the widely used weight loss medicine, such as row of health capsules. Such laxatives are easy to buy, inexpensive, fast-acting, strong laxative power, easy for patients to accept, but the long-term use of easy to produce dependence.
8 transdermal absorption grip medicine
In China, it is also called palm compress method. Treatment of accumulation and constipation in the elderly cold, available croton cream, dry ginger, ginger, white mustard seeds, sugar, betel nut of equal amount of powder, to the rice pill, the morning with pepper hot water to wash hands, in the palm coated with fragrant oil, each hold a pill of medicine, soon diarrhea. Beijing College of Traditional Chinese Medicine Professor Liu Du Zhou also introduced the use of this method to treat constipation in the elderly. Now Japan’s Sadao Watanabe is enthusiastically studying the relationship between drugs and qi in grip medicine. In the United States, there is a record of experimental grip medicine experiments confirmed. The most suitable points for the absorption of drugs in the human body are the Laogong point in the palm of the hand and the Indo point between the eyebrows. Grip medicine is absorbed through the skin, but its exact mechanism is not yet clear.
9 Comprehensive application
The Chinese medicine is chosen to be adjusted for a short period of time with Liouwei Anxiao Capsules, which broaden the middle and regulate Qi, moisten the bowels and regulate blood lipids. Polyethylene glycol with few adverse reactions is used for maintenance treatment, and the Chinese herbal medicine Ma Ren Run Yin Pill, Bai Zhu porridge, Wu Ren Japonica rice porridge, and Sang Ren porridge are chosen as porridge, and Jiang Chunying et al. used homemade medicine Ling Ling mushroom combination to treat functional constipation [12]. Most elderly patients with constipation have poor appetite and weak digestive and absorption functions, while congee is nutritious and easy to digest and absorb, and the medicinal congee made with Chinese herbs is both food and medicine, and can be given as food.
Of course, when choosing specific drugs, each patient’s specific situation must be considered. If the elderly person is combined with renal failure, volumetric laxatives, salt osmotic laxatives and stimulant laxatives should be avoided; if combined with cardiac insufficiency, salt osmotic laxatives should be avoided; if combined with severe diabetes mellitus, lactulose should be used with caution; if the elderly person has taken stimulant laxatives on his own for a long time and become dependent on them before consulting the doctor, a gradual reduction of stimulant laxatives should be considered. If you have been taking stimulant laxatives for a long time and have become dependent on them, you should consider gradually reducing the dosage of stimulant laxatives and replacing them with other safer drugs. (compiled by Xuefang Tian, a graduate student of Shandong University of Traditional Chinese Medicine)