Constipation in patients with comorbidity

Elderly and senile patients, due to physiological reasons and comorbid pathology, have a high risk of constipation. The causes of constipation are more often nutritional factors and age-associated diseases and damage to the colon (diverticular disease, colon ischemia, rectocele, hemorrhoids, and others); metabolic, endocrine disorders and neurological diseases. Age-related anatomical, structural and functional changes in the digestive system contribute to the development of constipation in the elderly. In patients of «silver age», there was an increase in the length of the gastrointestinal tract, the progression of atrophic, sclerotic changes in the mucous and submucosa, a decrease in the number of secretory cells, replacement of muscle fibers with connective tissue, etc. All this contributes to the slowing down of transit through the gastrointestinal tract and the violation of the act of defecation. Elderly lifestyles can also contribute to constipation. The low fiber content in the diet, the use of mainly thermally processed food, the violation of the rhythm of the diet (eating 1-2 times a day) are one of the causes of constipation in the elderly, which is facilitated by difficulty in chewing due to dental problems. Colonoscopy is ordered for all elderly and senile patients with constipation, and the identification of «anxiety symptoms» should be carried out at each patient visit. Regardless of the cause of secondary constipation, all patients should take a number of non-pharmacological measures, including lifestyle changes, a diet with adequate fiber, and fluid intake. Physical therapies may include medical gymnastics, colon massage to stimulate bowel movement at specific times. If non-drug measures are ineffective, it is recommended to use osmotic laxatives, as well as agents that increase the volume of feces. Psyllium supplementation is recommended for treatment of chronic constipation in elderly patients due to its high efficacy and safety.

1. Lazebnik L.B., Turkina S.V., Golovanova Ye.V., Ardatskaya M.D., Ostroumova O.D., Komissarenko I.A., Korochanskaya N.V., Kozlova I.V., Uspenskiy Yu.P., Fominykh Yu.A., Levchenko S.V., Loranskaya I.D., Tkachenko Ye. I., Sitkin S. I., Bakulin I. G., Bakulina N. V., Shemerovskiy K. A. Constipation in adults // Eksperimental'naya i klinicheskaya gastroenterologiya 2020;175(3): 10-33. DOI: 10.31146/1682-8658-ecg-175-3-10-33

2. Clinical guidelines. Constipation. MZ RF, 2020. Rossiyskaya Gastroenterologicheskaya Assotsiatsiya i Assotsiatsiya koloproktologov Rossii.

3. Wu C. Y., Chang W. P., Chang Y. H., Li C. P., Chuang C. M. The risk of irritable bowel syndrome inpatients with endometriosis during a 5-year follow-up: a nationwide population-based cohort study // Int JColorectal Dis. 2015; 30 (7): 907-912.

4. Enck P., Leinert J., Menno Smid M., et al. Somatic Comorbidity in Chronic Constipation: More Data from the GECCO Study // Gastroenterology Research and Practice. 2016; 1: 1-8. https://doi.org/10.1155/2016/5939238.

5. Choung R. S., Rey E., Locke G. R. III, et al. Chronic constipation and co-morbidities: A prospective population-based nested casecontrol study // United European Gastroenterology Journal. 2016; 4 (1): 142-151.

6. Deb B., Prichard D. O., Bharucha A. E. Constipation and Fecal Incontinence in the Elderly // Curr Gastroenterol Rep. 2020; 22 (11): 54. DOI: 10.1007/s11894-020-00791-1.

7. Abigail Maisey. A Practical Approach to Gastrointestinal Complications of Diabetes // Diabetes Ther. 2016; 7 (3): 379-386.

8. Noriko Ihana-Sugiyama, Naoyoshi Nagata, Ritsuko Yamamoto-Honda et al. Constipation, hard stools, fecal urgency, and incomplete evacuation, but not diarrhea is associated with diabetes and its related factors. Observational Study // World J Gastroenterol. 2016; 22 (11): 3252-3260.

9. Ardatskaya M. D., Achkasov S. I., Veselov V. V., Zarodnyuk I. V., Ivashkin V. T., Karpukhin O. Yu., Kashnikov V. N., Korotkikh N. N., Kostenko N. V., Kulovskaya D. P., Loranskaya I. D., Moskalev A. I., Sazhin A. V., Timerbulatov V. M., Trubacheva Yu. L., Frolov S. A., Shapoval'yants S. G., Shelygin Yu. A., Shifrin O. S., Yartsev P. A. Diverticular disease. // Koloproktologiya. 2021; 20(3):10-27. https://doi. org/10.33878/2073-7556-2021-20-3-10-27.

10. Ivashkin V. T., Mayev I. V., Kucheryavyy Yu. A., Lapina T. L. Clinical guidelines of the Russian Gastroenterological Association for the management of patients with abdominal pain. // Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2015; 25(4):71-80.

11. Lazebnik L.B. Age-related changes in the digestive system. // Klinicheskaya gerontologiya. 2006;1:1-8.

12. Bassotti G., Usai Satta P., Bellini M. Chronic Idiopathic Constipation in Adults: A Review on Current Guidelines and Emerging Treatment Options // Clin Exp Gastroenterol. 2021; 14: 413428. DOI: 10.2147/CEG.S256364.

13. Vazquez Roque M., Bouras E. P. Epidemiology and management of chronic constipation in elderly patients // Clin Interv Aging. 2015; 10: 919-930.

14. Emmanuel A., Mattace-Raso F., Neri M. C., Petersen K. U., Rey E., Rogers J. Constipation in older people: A consensus statement // Int J Clin Pract. 2017; 71 (1). DOI: 10.1111/ijcp.12920.

15. Zhang S., Wang R., Li D., Zhao L., Zhu L. Role of gut microbiota in functional constipation // Gastroenterol Rep (Oxf). 2021; 9 (5): 392-401. DOI: 10.1093/gastro/goab035.

16. Macedo M. I. P., Albuquerque M. F. M., Tahan S., Morais M. B. Is there any association between overweight, physical activity, fat and fiber intake with functional constipation in adolescents? // Scand J Gastroenterol. 2020; 55 (4): 414-420. DOI: 10.1080/00365521.2020.

17. Fathallah N., Bouchard D., de Parades V. Les regies hygieno-dietetiques dans la constipation chronique de l'adulte : du fantasme a la realite... [Diet and lifestyle rules in chronic constipation in adults: From fantasy to reality] // Presse Med. 2017; 46 (1): 23-30. French. DOI: 10.1016/j.lpm.2016.03.019.

18. Remes-Troche J. M., Coss-Adame E., Amieva-Balmori M., Velarde-Ruiz Velasco J. A., Gomez-Castanos P. C., Flores-Rendon R., Gomez-Escudero O., Rodn'guez-Lea! M. C., Duran-Rosas C., Pinto-Galvez S. M., Priego-Parra B. A., Triana-Romero A. Incidence of 'new-onset' constipation and associated factors during lockdown due to the COVID-19 pandemic // BMJ Open Gastroenterol. 2021; 8 (1): e000729. DOI: 10.1136/bmjgast-2021-000729.

19. Gao R., Tao Y., Zhou C., Li J., Wang X., Chen L., Li F., Guo L. Exercise therapy in patients with constipation: a systematic review and metaanalysis of randomized controlled trials // Scand J Gastroenterol. 2019; 54 (2): 169-177. DOI: 10.1080/00365521.2019.1568544.

20. Zhou C., Zhao E., Li Y., Jia Y., Li F. Exercise therapy of patients with irritable bowel syndrome: A systematic review of randomized controlled trials // Neurogastroenterol Motil. 2019; 31 (2): e13461. DOI: 10.1111/nmo.13461.

21. Wilson P. B. Associations between physical activity and constipation in adult Americans: Results from the National Health and Nutrition Examination Survey // Neurogastroenterol Motil. 2020; 32 (5): e13789. DOI: 10.1111/nmo.13789.

22. Chen C. L., Liang T. M., Chen H. H., Lee Y. Y., Chuang Y. C., Chen N. C. Constipation and Its Associated Factors among Patients with Dementia // Int J Environ Res Public Health. 2020; 17 (23): 9006. DOI: 10.3390/ijerph17239006.

23. Lacy B. E., Mearin, Lin Chang, Chey W. D., Lembo A. J., Simren M., Spiller R. Bowel disorders // Gastroenterology. 2016; 150: 1393-1407.

24. Hotz J., Plein K. Wirkung von Plantago-Samenschalen im Vergleich zu Weizenkleie auf Stuhlfrequenz und Beschwerden beim Colon-irritabile-Syndrom mit Obstipation [Effectiveness of plantago seed husks in comparison with wheat brain on stool frequency and manifestations of irritable colon syndrome with constipation] // Med Klin (Munich). 1994; 89 (12): 645-651. German. PMID: 7869999.

25. Dettmar P. W., Sykes J. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation // Curr Med Res Opin. 1998; 14 (4): 227-233. DOI: 10.1185/03007999809113363. PMID: 9891195.

26. Fleming V., Wade W. E. A review of laxative therapies for treatment of chronic constipation in older adults // Am J Geriatr Pharmacother. 2010; 8 (6): 514-550.

27. Noureddin S., Mohsen J., Payman A. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation // Complement Ther Med. 2018; 40: 1-7. DOI: 10.1016/j.ctim.2018.07.004.

28. Ford A. C., Moayyedi P., Lacy B. E. et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation // Am J Gastroenterol. 2014; 109 Suppl 1: 226.