CONSTIPATION AND FECAL INCONTINENCE.

CONSTIPATION

It is defined as excessively dry stool output, low (less than 50g/day) or infrequent (less than two bowel movements per week).

Epidemiology

The prevalence of constipation increases especially after age 60, and is more common in women than in men. Represents a major geriatric syndromes because of its prevalence, its serious complications and their significant impact on the quality of life of elderly. Only 5% of the elderly have fewer than three bowel movements a week.

Etiology

Causes of constipation in a patient are numerous and, in many cases, several causes coexist simultaneously:

-          Mechanical: obstructive, neoplastic, postoperative changes, volvulus, hernias.

-          Functional: diverticula, low fiber diet, anal fissure, anal prolapse, hemorrhoids, irritable bowel syndrome.

-          Pharmacological: laxatives, antidepressantstricyclics, calcium antagonists, antacids, opiates.

-          Metabolic and Endocrine: diabetes, uremia,hypokalemia, hypercalcemia, hypomagnesemia, hypothyroidism.

-          Neurological trauma, CNS disorders (Parkinson's disease, dementia, stroke and depression).

Treatment and recommendation nurse

Dietary treatment should be the first therapeutic step in the management of constipated patients. A diet rich in fiber is associated with an increased frequency and weight of stools.

Fiber works by increasing stool bulk, for bacterial growth, and decreasing intestinal transit time by stimulating bowel motility.

To achieve normal bowel function is advised to eat a moderate amount of vegetable fiber (of 10 60g/day) and plenty of water (1-2 liters / day) and physical exercise regularly. In order to check the response to dietary treatment should be eating about 30g of fiber or fiber 14.4 g of crude a day, for a month, along with a diet rich in fruits and vegetables and plenty of water.

In order to improve constipation, insoluble fiber (consisting of cellulose, hemicellulose and lignin) is more soluble than the (pectin, gums and mucilages), since the first captures more water, which results in a further increase in fecal mass and acceleration of intestinal transit.

Besides, insoluble fiber produces far less flatulence than soluble, suffering only partial fermentation in the colon (the soluble ferment completely).

Ostomy

Surgical creation of a temporary or permanent opening which brought about the exterior digestive tract through the abdominal wall.

Start working after 3-6 days after surgery.

Elderly iliostomizado: general advice

Causes:

-          Tumors

-          Ulcerative Colitis

-          Crohn's Disease.

Main differences colostomates elderly:

-          Increased chance of complications nutritional level (volume evacuated).

-          Impaired nutrient absorption.

-          You need to increase fluid intake because most of the water is absorbed in the intestine.

-          Risk of dehydration, increase the amount of water intake

Old man with gastrostomy: general advice. PEG

-          Start with water tolerated and when you can spend a nutritional formula either crushed diet kitchen.

-          Tolerance has to be gradual and cautious.

PEG (percutaneous endoscopic gastrostomy)

-          The first day absolute diet, serum scheduled as needed and schedule (Performing Control Rx)

-          Second day, liquid / glucose 5%. PEG + 1250 ml Serum IV scheduled.

-          Third day, tickets for PEG 1450ml (BCP Formulas) + cover needs with serum.

Fecal Incontinence

Fecal incontinence is not part of normal aging, representing one of the geriatric syndromes that impact on quality of life of elderly and more overhead to the caregiver, with a great impact, not only physical (pressure ulcers, urinary infections ... ) but also economic (derived from spending that generates high intake of geriatric care absorbent and additions) and psychosocial (causing a progressive deterioration in personal and social relationships of patients).

In my opinion there are the main nursing interventions:

1.    Medication Management. (To facilitate the safe and effective use of medicines prescribed and counter).

2. Prescribe medication. (Prescribe medication for a health problem).

3. Bowel management. (Establishment and maintenance of a regular pattern bowel movement).

4. Intestinal Training. (Help the patient in the education of the intestine to evacuate at specified intervals).

5. Management of Constipation / impaction. (Prevention / relief of constipation / impaction).

6. Stages in the diet. (Institute the necessary restrictions on the diet with subsequent progression same as tolerated).

7. Management of nutrition. (To help provide a balanced diet of solids and liquids).

8. Liquid handling. (To maintain fluid balance and prevention of complications resulting from abnormal fluid levels or unwanted).

9. Monitoring fluids. (Collection and analysis of patient data to regulate the acid-base balance).

BIBLIOGRAPHY: 

- Romero Y, Evans JM, Fleming KC, Phillips SF; Constipation and fecal incontinence in the elderly population;Mayo Clin Proc. 1996 Jan;71(1):81-92., available in: http://www.ncbi.nlm.nih.gov/pubmed/8538239

- Livestrong; [quoted the 6/05/13 and available in: http://www.livestrong.com/article/149464-causes-of-elderly-fecal-incontinence/

- FelixW. Leung, Satish S.C. Rao; Fecal Incontinence in the Elderly; Gastroenterol Clin N Am 38 (2009) 503–511, available in: http://xa.yimg.com/kq/groups/21126260/478307167/name/incontin%C3%AAncia+fecal.pdf