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Constipation, Faecal and Urinary Incontinence

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Advanced Age Geriatric Care

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Abstract

Constipation is a common problem in the elderly. Slow colon transit, irritable bowel syndrome and pelvic floor dysfunction are three distinct pathophysiologies causing constipation. Many age-related problems such as multiple medical conditions, increased use of medications, decreased mobility and dietary changes contribute to constipation. Secondary constipation is due to neurological diseases, endocrine and metabolic diseases, psychological conditions and structural abnormalities. There are three types of faecal incontinence: (i) urge incontinence, (ii) passive incontinence, and (iii) faecal seepage. Choice of proper therapy will depend on the cause and severity of the incontinence. Urinary incontinence (UI) is one of the biggest challenges facing the elderly population. In the elderly, the risk factors are multifactorial, among them being age-related changes, comorbidity, polypharmacy and functional impairments. Treatment of UI includes behavioural and pharmacological interventions.

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Author information

Authors and Affiliations

  1. Geriatric Medicine, Rehabilitation and Aged Care Service, Blacktown-Mt Druitt Hospital, Blacktown, NSW, Australia

    Gary Cheuk

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Nages Nagaratnam

Authors
  1. Gary Cheuk
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  2. Nages Nagaratnam
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Corresponding author

Correspondence to Gary Cheuk .

Editor information

Editors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Nages Nagaratnam

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Kujan Nagaratnam

  3. Rehabilitation and Aged Care Service, Blacktown-Mt Druitt Hospital, Blacktown, NSW, Australia

    Gary Cheuk

Multiple Choice Questions

Multiple Choice Questions

Answers at the end of References

  1. 1.

    The following in relation to constipation are true EXCEPT:

    1. A.

      Constipation in the elderly may be a sign of a more serious underlying problem such as a mass lesion.

    2. B.

      Constipation is three bowel movements per fortnight.

    3. C.

      Frailty and bedridden contributes to increased prevalence.

    4. D.

      Increased use of medications with side-effect profile is an important cause of constipation in the elderly.

  2. 2.

    In the management of chronic constipation in the elderly, the following are true EXCEPT:

    1. A.

      First step is to improve bowel regularity – increased fluid intake, high fibre diet and physical exercise.

    2. B.

      Bulk-forming laxatives increase stool mass softness by absorbing water from the intestinal lumen.

    3. C.

      Impacted faeces are removed by enema, stool softeners and long-term use of laxatives.

    4. D.

      Osmotic laxatives cause secretion of water into the lumen by osmotic activity.

  3. 3.

    The following are true of faecal incontinence, EXCEPT:

    1. A.

      Faecal impaction is associated with faecal incontinence.

    2. B.

      In the elderly faecal incontinence is more often related to multiple medical diagnoses.

    3. C.

      Postsurgical sphincter damage is the commonest cause.

    4. D.

      Diminished sensation and lack of anal contraction ‘winking’ indicate an underlying neurological condition.

  4. 4.

    The following are true of urinary incontinence, EXCEPT:

    1. A.

      In men stress incontinence is uncommon.

    2. B.

      In the elderly common voiding problem is urgency with urge incontinence, and bladder overactivity is a common underlying factor.

    3. C.

      In frail elderly detrusor hyperactivity with impaired contractility (DHIC) leads to decreased post-void residual urine (PVR).

    4. D.

      A PVR of less than 50 ml is indicative of satisfactory bladder emptying.

MCQ Answers

  1. 1.

    A

  2. 2.

    B

  3. 3.

    C

  4. 4.

    C

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Cheuk, G., Nagaratnam, N. (2019). Constipation, Faecal and Urinary Incontinence. In: Nagaratnam, N., Nagaratnam, K., Cheuk, G. (eds) Advanced Age Geriatric Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96998-5_26

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  • DOI: https://doi.org/10.1007/978-3-319-96998-5_26

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