Original Article

Pathophysiology of the functional constipation in elderly

10.34057/PPj.2019.38.02.006

  • MICHAEL D. LEVIN

Pelviperineology 2019;38(2):53-57

Abstract:

The aim of this study was to investigate the pathophysiology of functional constipation (FC) in the elderly.

Material and methods:

In the State Geriatric Center of Netanya (Israel), 37 patients at the age of 65-93 years with complaints of chronic constipation were examined. This main group did not include patients with tumors and cases after surgery on the rectum and colon. The results of a survey of 15 young people aged 11-17 years with no bowel disease were taken as a control group. A barium enema with a radiopaque marker near the anus was produced. A frontal radiograph of the abdomen as well as an X-ray of the lateral projection of the anorectal zone were made after the administration of 100, 200 and 300 ml of barium.

Results:

In 6 (16%) cases, the width of the rectum was more than 5 cm - megarectum. The length of the anal canal was 2 times less than the minimum normal limit after the injection of 100 ml of barium. In 25 (68%) patients, the width of the rectum was normal and had a normal shape. The functioning anal canal length was shortened during the administration of barium. In 6 (16%) patients, the reason for constipation was high colonic tone. They had the anorectal parameters within the normal range.

Conclusion:

We found 3 types of FC in the elderly. In the structure of FC the cases of self-defined constipation (68%) are dominated, where there is no mechanical obstruction for defecation. The reason for the sense of constipation and incomplete emptying is due to the age-related weakness of the pelvic floor muscles. In 16% of patients, obstructive constipation with a megarectum and a fixed descending perineum syndrome was detected. This pathology originated in childhood or after anal fissures, and childbirth. In 16% of patients, the cause of constipation was a high tone of the colon, what can be the result of an irritable bowel syndrome, the formation of functional sphincters in the colon and diverticula of the sigmoid colon. An increase in the tone of the colon causes a slow transit constipation.

Keywords: Elderly,Barium enema,Functional constipation,Outlet obstruction,Slow transit constipation,Anal canal length