5 Severe Constipation Complications in the Elderly.

Severe constipation is a common issue among the elderly, leading to various complications that can significantly impact their quality of life. Understanding these complications and why the elderly are more susceptible to them is crucial for prevention and management. 

This article explores the common complications associated with severe constipation in older adults and delves into the factors that increase their vulnerability.

Complications of Severe Constipation in the Elderly Include:

• Stool Impaction
• Stool Incontinence
• Overflow Diarrhea
• Anal Fissures
• Hemorrhoids (Piles)
• Others: Rectal prolapse, rectal ulcers, intestinal obstruction, or intestinal perforation.

Why Are Constipation and Its Complications More Common in the Elderly?

The elderly are often at a higher risk of constipation and its complications.

• Up to 70% of the elderly in nursing homes suffer from severe constipation.
• Among them, about 7% will have fecal impaction during examination (reference).

Several risk factors make constipation and its complications more prevalent in the elderly (reference).

Reasons the Elderly Are at Higher Risk of Constipation:

• Lack of Physical Activity
• General Disability
• Low Caloric Intake: Inadequate eating is a risk factor for severe constipation.
• Common Constipation-Predisposing Diseases: Diabetes, chronic renal diseases, hypothyroidism, cerebrovascular diseases, Parkinsonism, autonomic neuropathy, dementia, and others.
• Medications That Cause Constipation: Analgesics, antidepressants, some antihypertensives, antiparkinsonian drugs, iron supplements, antihistamines, diuretics, and others.

For more information, read: 6 Constipation Danger Signs.

The factors above also contribute to a higher incidence of constipation complications. Older age increases the risk of complicated constipation due to limited mobility, low food intake, and general disability.

1. Fecal Impaction

What Is Fecal Impaction?

Fecal impaction is a common complication of constipation in elderly, debilitated people. Prolonged severe constipation leads to stool hardening, forming a mass in the last part of the colon. The elderly with fecal impaction cannot pass this impacted mass through normal defecation.

Who Is at Higher Risk of Fecal Impaction?

• Elderly Females
• Reduced Physical Activity
• Bedridden Debilitated Elderly
• Neurological Diseases: Parkinson’s disease, spinal cord injuries, multiple sclerosis, and others.
• Regular Use of Certain Medications: Non-steroidal anti-inflammatory drugs and some antihypertensives.

Symptoms

• Prolonged severe constipation (lasting a week or more).
• A sensation of a poop mass in the rectum that is too big to come out.
• Abdominal pain that increases after meals.
• Sometimes, liquid stool leaking around the impacted feces (false diarrhea).
• Recent onset of anorexia (loss of appetite).
• Progressive bloating; visible distension is also noticeable.
• Nausea and vomiting may occur.
• A sense of increased fatigue and headache.

What to Do If You Suspect Fecal Impaction?

If you suspect fecal impaction, please contact your doctor or nurse. Laxatives may be ineffective for fecal impaction in the elderly. Moreover, using large doses of laxatives may worsen the condition. Fecal impaction may require manual disimpaction.

Learn More: How Do You Know Fecal Impaction Has Been Cleared?

2. Stool Incontinence & Overflow Diarrhea

Stool Incontinence

Severe constipation in the elderly is often associated with damage to the muscle rings at the end of the rectum. Prolonged constipation and recurrent straining can lead to stool incontinence due to sphincter damage.

Stool incontinence can manifest as:

• Inability to Control Stool Passage: Difficulty reaching the toilet in time after feeling the urge to poop.
• Soiling Accidents: Passage of stool or mucus without awareness.

Learn more about stool incontinence.

Overflow Diarrhea (a Complication of Stool Impaction)

Severe constipation leading to stool impaction obstructs the rectum with a hard stool mass. The stool above becomes liquefied and leaks around the mass, resulting in overflow diarrhea—a complication common in the elderly.

Overflow diarrhea is another cause of incontinence in the elderly. The larger the fecal mass, the greater the stretch of the rectal wall, which can lead to relaxation of the anal sphincter and subsequent incontinence.

Symptoms of overflow diarrhea are similar to those of stool impaction (constant urge to poop, sense of incomplete evacuation), plus diarrhea or incontinence.

3. Anal Fissures

The anal canal is a short tubular structure surrounded by muscle rings, forming the last part of your colon and digestive tract. Severe constipation in the elderly can lead to a tear in the wall of the anal canal, known as an anal fissure. While fissures are common and typically heal quickly, they tend to become persistent in the elderly due to complications.

Symptoms of Anal Fissures

• Sharp pain during a bowel movement in the anal canal.
• Pain that starts with defecation and may last for minutes to hours.
• Sometimes, bright red blood on the stool or toilet paper after bowel movements.
• A small lump or skin tag near the fissure.

Constipation leads to anal fissures, and fissure pain leads to fear of defecation, which in turn leads to more constipation. This vicious cycle may lead to severe complications like fecal impaction in the elderly.

Detection and treatment of anal fissures are important, as elderly individuals with painful fissures often have difficult-to-treat constipation.

4. Hemorrhoids (Piles)

Prolonged constipation and straining in the elderly can cause dilation of the veins in the anus and lower rectum, leading to hemorrhoids. Severe constipation is a major risk factor for piles, which are widespread, especially in older adults.

Symptoms

• Often asymptomatic.
• Occasionally causes mild pain or irritation in the anal area.
• A swelling or skin tag around the anus.
• Bleeding (mixed with stool or blood passing without stool).
• Signs of complications include dizziness, shortness of breath, and rapid heartbeat—symptoms of anemia from bleeding piles.
• Hemorrhoids may become thrombosed and inflamed, causing severe pain and swelling in the anal canal.

5. Others

Severe constipation in the elderly may also lead to other complications, which, although less frequent, can cause significant illness and disability:

• Rectal Prolapse: Over-straining leads to the protrusion of the last part of the rectum beyond the anus.
• Complete Intestinal Obstruction
• Rectal Ulcers
• Large Bowel Perforation

Conclusion

Constipation and its complications are significant health concerns for the elderly, often resulting from a combination of reduced mobility, underlying health conditions, and medication use. Early recognition and management are essential to prevent these complications and improve the quality of life for older adults. If you or a loved one is experiencing symptoms of severe constipation, it is important to seek medical advice promptly.