Valoración y tratamiento del estreñimiento en el anciano | Revista Española de Geriatría y Gerontología

Article information

Resumen

El estreñimiento o constipación es un problema muy frecuente en las personas mayores y, además, tiene muchas implicaciones sanitarias y psicológicas. El envejecimiento supone la unión de factores que convergen en la aparición del estreñimiento tales como: inmovilidad, deshidratación o simplemente la polimedicación. La tendencia a banalizar este estreñimiento como enfermedad puede ocasionar complicaciones y problemas físicos en las personas que lo presentan. Durante la siguiente revisión analizaremos la epidemiología, el correcto diagnóstico y el tratamiento, tanto farmacológico como no farmacológico, del estreñimiento en personas mayores. El paciente anciano deberá seguir unas normas no farmacológicas iniciales de movilidad, hidratación e ingesta de fibra, y utilizar los laxantes cuando las medidas no farmacológicas no son suficientes. Así, se analizarán los diferentes tratamientos y la conveniencia de cada uno en los distintos casos.

Palabras clave:

Estreñimiento

Ancianos

Tratamiento

Abstract

Constipation is a highly frequent problem in the elderly and it has many health and psychological implications. Ageing implies a combination of factors that converge in the appearance of constipation, including immobility, dehydration and polypharmacy. The tendency to trivialise constipation as a pathology may cause complications and physical problems in sufferers. The following review analyses the epidemiology, correct diagnosis and pharmacological and non-pharmacological treatment of constipation in the elderly. The elderly patient should follow certain initial non-pharmacological recommendations, such as mobility, hydration and fibre intake, and use laxatives whenever nonpharmacological measures prove insufficient. The review includes an analysis of various treatments and the advisability of one rather than another in distinct cases.

Key words:

Constipation

The elderly

Therapy

Full text is only aviable in PDF

Bibliografía

[1.]

W.E. Whitehead, S. Chaussade, E.L. Corazziari.

Report of an international workshop on management of constipation.

Gastroenterol Int, 4 (1991), pp. 99-113

[2.]

P.D. Higgins, J.F. Johanson.

Epidemiology of constipation in North America: a systematic review.

Am J Gastroenterol, 99 (2004), pp. 750-759

http://dx.doi.org/10.1111/j.1572-0241.2004.04114.x | Medline

[3.]

E. Hammond.

Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women.

Am J Pub Health, 54 (1964), pp. 11-23

Medline

[4.]

N.J. Talley, K.C. Fleming, J.M. Evans, et al.

Constipation in an elderly community: a study of prevalence and potential risk factors.

Am J Gastroenterol, 91 (1996), pp. 19-25

Medline

[5.]

A.M. De Schryver, Y.C. Keulemans, H.P. Peters, et al.

Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation.

Scand J Gastroenterol, 40 (2005), pp. 422-429

Medline

[6.]

M.P. García-Caselles, R. Miralles.

Estreñimiento en el anciano. Enfermedades del aparato digestivo en las personas mayores. Monografías en Geriatría. Formación continuada. Cátedra de Geriatría, Universidad Complutense de Madrid.

Editorial Glosa, (2004),

[7.]

J. Golzarian, H.W. Scout Jr, W.O. Richards.

Hypermagnesemia-induced paralytic ileus.

Dig Dis Sci, 39 (1994), pp. 1138-1142

Medline

[8.]

F. Tison, I. Ghorayeb.

Parkinson's disease and associated disorders.

Rev Pract, 55 (2005), pp. 741-747

[9.]

C. Ng, G. Prott, S. Rutkowski, et al.

Gastrointestinal symptoms in spinal cord injury: relationships with level of injury and psychologic factors.

Dis Colon Rectum, 48 (2005), pp. 1562-1568

http://dx.doi.org/10.1007/s10350-005-0061-5 | Medline

[10.]

K. Wrenn.

Fecal impaction: current concepts.

N Engl J Med, 7 (1989), pp. 658-662

[11.]

P. Marquis, C. De La Loge, D. Dubois, et al.

Developement and validation of the patient assessment of constipation Quality of Life questionnaire.

Scand J Gastroenterol, 40 (2005), pp. 540-551

http://dx.doi.org/10.1080/00365520510012208 | Medline

[12.]

S.J. Lewis, K.W. Heaton.

Stool form as a useful guide to intestinal transit time.

Scand J Gastroenterol, 32 (1997), pp. 920-924

http://dx.doi.org/10.3109/00365529709011203 | Medline

[13.]

K. Mimidis, D. Galinsky, E. Rimon, et al.

Use of a device that applies external kneading-like force on the abdomen for treatment of constipation.

World J Gastroenterol, 11 (2005), pp. 1971-1975

Medline

[14.]

G. Chiaroni, L. Salandini, W.E. Whitehead.

Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation.

Gastroenterology, 129 (2005), pp. 86-97

Medline

[15.]

X. Fernández-Fraga, F. Azpiroz, M. Casaus, et al.

Responses of anal constipation to biofeedback treatment.

Scand J Gastroenterol, 40 (2005), pp. 20-27

Medline

[16.]

M. Pescatori.

Systematic review of sacral nerve stimulation for faecal incontinence and constipation.

Br J Surg, 91 (2004), pp. 1559-1569

http://dx.doi.org/10.1002/bjs.4796 | Medline

[17.]

M. Scarpa, M. Barollo, M.R. Keighley.

Ileostomy for constipation: long-term postoperative outcome.

Colorectal Dis, 7 (2005), pp. 224-227

http://dx.doi.org/10.1111/j.1463-1318.2005.00810.x | Medline

[18.]

A.P. Wilson Joanne.

Constipation in the elderly.

Clin Geriatr Med, 15 (1999), pp. 499-510

Medline

[19.]

M. Camilleri, W.G. Thompson, J.W. Fleshman, et al.

Clinical management of intractable constipation.

Ann Intern Med, 121 (1994), pp. 520-528

Medline

[20.]

L.R. Schiller.

Constipation and fecal incontinence in the elderly.

Gastroenterol Clin North Am, 30 (2001), pp. 497-515

Medline

[21.]

B.A. Clark, R.S Brown.

Unsuspected morbid hypermagnesemia in elderly patients.

An J Neprol, 12 (1992), pp. 336-343

[22.]

M. Kontani, A. Hara, S. Ohta, et al.

Hypermagnesemia induced by massive catartic ingestion in an elderly women without pre-existing renal dysfunction.

Intern Med, 44 (2005), pp. 448-452

Medline

[23.]

Laxantes con alto contenido en fosfatos: riesgo de hiperfosfatemia. Agencia española de medicamentos y productos sanitarios. Comunicación sobre riesgos de medicamentos para profesionales sanitarios. Ref: 2004/16.21 de diciembre de 2004. Disponible en: http://www.agemed.es

[24.]

L. Volicer, P. Lane, J. Panke, et al.

Management of constipation in residents with dementia: sorbitol effectiveness and cost.

J Am Med Dir Assoc, 6 (2005), pp. 2-4

[25.]

A. Attar, M. Lemann, A. Ferguson, et al.

Comparison of low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation.

Gut, 44 (1999), pp. 226-230

Medline

[26.]

P. Culbert, H. Gillet, A. Ferguson.

Highly effective oral therapy (polyethylene glycol + electrolyte solution) for faecal impaction and severe constipation.