First, constipation in the elderly refers to the reduction of defecation times, difficulty in defecation and dry feces. Normal people defecate 1 ~ 2 times a day or defecate 1 time for 2 ~ 3 days. Constipation patients defecate less than twice a week, defecation is laborious, and feces are hard and small. Constipation is a common symptom of the elderly. About13 of the elderly have constipation, which seriously affects their quality of life. Age: Elderly patients, especially those who are weak, unable to move or bedridden, are prone to simple constipation. However, when elderly patients have intractable constipation, they must think that it is caused by obstruction of left colon or rectal cancer. Colorectal cancer is more common in people over 50 years old, but about 20% of them are found in young adults and newborns with intractable constipation, so it should be considered as congenital megacolon or congenital anal stenosis atresia.
Second, rectal intussusception: also known as rectal prolapse, recessive rectal prolapse. Most people have a long history of defecation, and defecation is laborious, which takes several hours every day. They find it difficult to defecate and need to dig it out with their fingers or put pressure on the perineum to help defecate. Because of pudendal nerve injury, fecal incontinence may occur in the later stage. Mucous blood may appear due to edema and ulcer of proctitis. More common in women over 50 years old, intussusception is mostly reset after defecation, intussusception is mostly at the anal margin, and there is less anus. The diagnosis is difficult, which can not be found by routine examination, and defecography can make a definite diagnosis.
Third, the front wall of the rectum protrudes: the normal front wall of the rectum is separated from the vagina by the rectovaginal septum. When defecating forcibly, the anterior wall of rectum is prone to protrude forward, and when the rectovaginal septum is relaxed, it is more prone to protrude. When the patient defecates, the pressure in the rectum is led to the vagina instead of the anus, and fecal lumps accumulate in the protruding depressions, which causes difficulty in defecation, and besides constipation, local pain and bloody stool may also occur. Typical cases can feel the pressure drop in anus, or press pubic bone or insert fingers into vagina or rectum to defecate.
Fourth, patients with acute constipation often have abdominal pain, bloating, and even nausea and vomiting, which are more common in intestinal obstruction for various reasons; Chronic constipation has no special manifestations. Some patients complain of bitter mouth, loss of appetite, abdominal distension, abdominal discomfort or nervous system symptoms such as dizziness, headache and fatigue, but they are generally not serious. The discharged feces are as hard as sheep dung, and there may be spasmodic pain and heaving sensation in the left abdomen or lower abdomen when defecating, and the spasmodic S-shaped colon can often be touched in the left lower abdomen. People with serious difficulty in defecation may have bloody stool or bloody stool due to the aggravation of hemorrhoids and anal fissure, and patients will also be nervous and anxious. Chronic habitual constipation mostly occurs in middle-aged and elderly people, especially in puerperal women, which may be related to the decrease of intestinal muscle, abdominal muscle and pelvic floor muscle tension.