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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
‘Faecal impaction' is a term for a mass of hard faeces within the rectum that cannot be easily passed (i.e. large hard stools). The mechanism that provokes FI appears to be a reduced rectal sensation capacity secondary to the faecal mass rather than the faecal mass affecting internal anal sphincter function.59 The causes are those of constipation (see page 275) and frail older people are particularly susceptible. It is often associated with multi-morbidity, polypharmacy and the prescription of constipating medications (see Table 12.1).60 It should be suspected when such a person has an unexplained clinical deterioration, especially when bowel habit alters.61 Specific presenting symptoms include nausea, vomiting, abdominal pain, paradoxical diarrhoea and subsequent FI, but non-specific presentations, such as delirium, are well recognised. The faecal bulk may precipitate urinary retention or incontinence (see page 257). Rarely, pressure on the intestinal wall may provoke ulceration, bleeding or perforation. It is usually managed with a combination of laxatives and enemas. Infrequently, failed medical therapy necessitates manual evacuation. A regimen of high-dose polyethylene glycol/electrolyte solution for up to three days has been shown to be effective in resolving impaction with minimal adverse effects.62
Chronic Idiopathic Constipation
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Fecal impaction is a significant problem in elderly individuals who are institutionalized (55). Mental confustion, immobility, or inadequate toilet arrangements may contribute to failure to act on the urge to defecate, and dyschezia may occur when the fecal bolus becomes too large or uncomfortable to pass. The development of megarectum blunts rectal sensation; this often persists after disimpaction (56) and predisposes such patients to reaccumulate feces unless scrupulous toileting programs are instituted. Fecal impaction is the most common cause of spurious diarrhea and of fecal incontinence in the institutionalized elderly (57).
Unexplained Fever Associated with Diseases of the Gastrointestinal Tract
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
On physical examination, the following features should be noted: general, mental, and nutritional condition and especially, state of hydration. In a severely dehydrated patient, restoration of fluid and electrolyte balance is a medical emergency and takes precedence over making a diagnosis. Abdominal findings may include tenderness, a mass, fullness due to matted loops of bowel (as occurs in Crohn’s disease), hepatosplenomegaly, and ascites. Rectal examination may reveal a mass or fecal impaction. General examination may disclose flushing (suggestive of carcinoid syndrome), goiter, and lymphadenopathy (lymphoma, Whipple’s disease), signs of advanced atherosclerosis (possibly accompanying mesenteric ischemia), evidence of collagen-vascular disease (mesenteric arteritis), fistulae (Crohn’s disease), jaundice, clubbing of the fingers, and skin rashes.
Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials
Published in Scandinavian Journal of Gastroenterology, 2019
Ruitong Gao, Yujia Tao, Changli Zhou, Jinwei Li, Xige Wang, Lei Chen, Feng Li, Lirong Guo
There has been a recent increase in focus on the effect of exercise therapy on constipation, with researchers proposing that exercise programs or enhancements in habitual physical activity may decrease constipation complaints in patients. A Spanish survey [16] revealed that low physical activity appeared to play a significant role in fecal impaction. A cohort of 62,036 women surveyed as part of the Nurses’ Health Study [17] revealed that moderate physical activity was associated with a decreased constipation risk. However, some studies have shown that exercise can improve the quality of life for those adults affected by constipation, but that it cannot alleviate the symptoms of this disorder [18]. Similarly, some studies have found no link between regular aerobic exercise and gastrointestinal transit time [19]. The relationship between physical exercise and constipation is thus unclear, with key uncertainties with regard to whether exercise can improve constipation, and if so whether certain forms, durations, or intensities of exercise are better able to do so. Given these uncertainties, we performed this systematic review and meta-analysis aimed at analyzing the effects of exercise interventions on constipation in affected patients.
Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender
Published in Scandinavian Journal of Gastroenterology, 2018
Maria Pina Dore, Giovanni Mario Pes, Stefano Bibbò, Patrizia Tedde, Gabrio Bassotti
Constipation is a common complaint and the prevalence of self-reported constipation in the adult population is estimated to be around 30% [1], with the female gender preferentially affected. Observational and prospective epidemiological studies in both Western [2] and Eastern [3] countries have reported different frequencies according to age. In community-dwelling elderly people [4] or in those residing in long-term facilities [5] the prevalence may rise to 60%. Constipation affects especially older adults and may result in deterioration of health-related quality of life. Patients often complain difficult stool passage usually associated with hardened feces, straining and unsatisfactory defecation [6]. Additional symptoms may include abdominal pain and/or discomfort and bloating. Patients may experience complications such as overflow fecal incontinence, hemorrhoids, anal fissures and fecal impaction that may require hospitalization [7].
Effect of constipation on outcomes in mechanically ventilated patients
Published in Baylor University Medical Center Proceedings, 2022
Hassam Ali, Rahul Pamarthy, Swethaa Manickam, Shiza Sarfraz, Mitra Sahebazamani, Hossein Movahed
This study reported that constipation did not increase mortality in critically ill patients, which is consistent with a previous report.4 In critically ill patients with constipation, several comorbidities can increase mortality. Using multivariate logistic regression analysis, it was revealed that constipation-related conditions such as bowel obstruction and fecal impaction significantly increased mortality. However, diverticulitis or diverticulosis had no effect on mortality. This finding is consistent with a previous study that reported a significant impact of fecal impaction on mortality rates, as much as 22%.28 It is critical to monitor patients with fecal impaction for additional comorbidities outlined above, as they increase inpatient mortality.