Many chronic bowel health problems are associated with ageing, including chronic constipation, diarrhoea and faecal incontinence, and can lead to more serious complications and reduced quality of life. Pharmacists can play a key role in helping older Australians manage such issues.
Chronic bowel issues are a common problem in the elderly population and become more common as we age. According to the Department of Health and Aged Care, “people aged 85 years are five times more likely [than those younger] to experience severe incontinence”.[1]
The Continence Foundation of Australia suggests that one in four adult Australians is affected by incontinence, with faecal incontinence affecting “six per cent of Australian men and 10 per of Australian women”.[2]. The Foundation also states that “faecal incontinence is one of the three major reasons … for admittance to a residential care facility”.2
In the elderly, the common chronic bowel issues of constipation, diarrhoea and incontinence can be caused by a variety of factors, including medications, poor diet, lifestyle and medical conditions.
Community pharmacist and accredited herbalist Gerald Quigley says that among the reasons bowel issues are more common in the elderly is a change in the way our muscles work. This includes the muscles responsible for peristalsis, which is the action that moves food through the digestive tract.
Additionally, Mr Quigley says, we tend to assume that the muscles “at the end, which control excretion … will be just as strong” as we age. This may not be the case, he adds, and declining muscle strength in this area may contribute to some of the bowel issues older patients face.
“Muscles that we expect will work forever … just begin to fatigue,” he said. “Sure, there could be some disease states … [and] there could be other issues as well, but the most common … it’s just muscle fatigue.”
Mr Quigley says bowel issues are seen “more in women than in men”, which may be attributed to changes that happen as a result of childbirth.
“It becomes a real issue,” he said, “where you’re plagued with the risk of having an accident, losing control, and with that comes embarrassment, withdrawal from society – and … this is a very serious issue”.
He points out that men also have issues with faecal incontinence, which can be due to such procedures as biopsies, including tests for prostate cancer. These, he adds, can “cause enormous issues”.
Common bowel issues
While bowel changes that result in issues associated with chronic constipation and/or diarrhoea (along with continence issues) are more common as we age, Mr Quigley says the most problematic concern here – that impacts quality of life – is faecal incontinence – “just the inability to control the regularity that we had in the earlier days”.
“Most people have grown up with a concept that you need to go to the toilet twice a day, or once a day … And when that normal lifestyle flow is taken away, or it can’t be controlled, it causes enormous emotional issues,” he said.
Mr Quigley says that while incontinence is probably “the most upsetting” of the bowel issues that can happen as we age, others include chronic constipation, which can be the result of the medications people are taking.
Prevention and management
Preventing bowel issues can be related to “what the underlying cause is”, which can be difficult to identify, but If pharmacists can help patients determine what the cause of their bowel issue is, “then things will improve quite dramatically”, Mr Quigley says.
Pointing to various examples, he suggests common issues that can precipitate bowel concerns include food problems, stress and medications.
“If it’s a stress-related issue, which can be a little vaguer in terms of trying to [identify the cause], there are lots of good stress adaptogenic herbs, which are very gentle [but] will make a real difference,” he said.
If the issue is medication related, he adds, it’s important to help the patient understand the side effects of certain medications, which takes time and patience.
Prevention in many instances is possible, but as Mr Quigley says, “it’s a matter of trying to find what the underlying cause is”.
Addressing the prevention of constipation, he cites those foods “that can loosen up” the bowels – for example, pears and prunes.
“If an older person is having pears or prunes <itals>in case<itals> they get constipated, [and] they’re then getting loose bowel motions that are causing them concerns, telling them to stop enjoying prunes every morning on their cereal is almost like having them try to extract a tooth without anaesthetic,” Mr Quigley said.
“There’s a very delicate balance between being comfortable and not going too far the other way, and it’s a real challenge for many people,” he continued.
Managing bowel issues is important because chronic constipation and/or diarrhoea may lead to worse health outcomes.
“If you have chronic loose motions, a lot of the reabsorption of nutrients that happens in your intestine is not happening correctly,” Mr Quigley said. “So, fat-soluble vitamins, in particular, water absorption … all of that is just not happening.
“A person who is chronically constipated probably doesn’t have those same issues, but from that perspective, that’s just waste that a person can’t get rid of – that can clog up: it can cause some serious issues because, really, it’s like a blocked drain. It normally means you’re really feeling quite unwell, quite sluggish, painful, and bloated, and you can in fact become impacted.
“With diarrhoea, on the other hand, you’re often devoid of a lot of the common minerals and electrolytes, and that’s why things like Hydrolyte are so important as mineral replacement drinks and electrolyte replacement drinks in managing diarrhoea-associated issues.
“This is where a dietitian can keep a food diary, look at what’s going on, look at when the bowel actions are happening, and look at the consistency using a Bristol Stool Chart,” he said.
Pharmacy options
For patients with chronic diarrhoea and/or faecal incontinence, favoured pharmacy options, according to Mr Quigley, include Gastro-stop and similar products, which he says “are underused for many people”.
“They only have a short duration of action,” he said, “and just to have someone load up on something like Gastro-stop before their weekly shop can make an enormous difference to their quality of life.”
Mr Quigley continued: “I’ve seen many people over the years plan their trip around a shopping centre where they can have comfort knowing there’s a toilet ‘just over there’.”
When it comes to bowel issues in the elderly, Mr Quigley says “the most upsetting, the most public, is diarrhoea”.
“So, again, identifying the underlying reasons is the biggest challenge,” he said. “And that might mean there’s a change in medication, where the risk of either constipation and/or diarrhoea is less or removed. And that’s where the pharmacist can be really involved – in suggesting the doctor change some things.
“From a treatment perspective, there’s always that reassurance that there are aids available,” he continued. “There are continence pads for both men and women. And there’s no shame in discussing these products.”
For patients with bowel infections, Mr Quigley says there’s “a role for appropriate probiotics like saccharomyces, which are protective”. And there’s “a role for just general good eating,” he adds, which might mean getting a dietitian or nutritionist involved.
Constipation issues can be assisted through ensuring fibre intake. While fibre supplements such as Metamucil and Benefiber are available in pharmacies, Mr Quigley suggests starting with a food-first approach and encouraging adequate dietary fibre consumption.
“Most Australians don’t eat enough fibre,” he said. “Fibre is fundamental for bulking and regular bowel actions. Fibre is underrated. High-fibre foods are very important … but with fibre, you’ve got to drink lots of water.”
Role of pharmacy
Pharmacists are an integral part of managing chronic bowel issues in the elderly, including education around medication management, lifestyle modifications, diet and nutrition, and OTC product advice.
Understanding the causes and treatments for chronic bowel issues, pharmacists can help to improve the quality of life for patients and reduce the risk of long-term complications.
“Make sure the ‘bums and tums’ section [in your pharmacy] is clearly identified, and there are products that you’re confident discussing and confident that will help in alleviating bowel issues,” Mr Quigley said.
“And get others involved,” he added, referring to additional services such as dietitians and other specialists. “Patients love that. It shows that you care.”
References:
- health.gov.au/topics/bladder-and-bowel/bladder-and-bowel-throughout-life/bladder-and-bowel-for-older-australians
- continence.org.au/about-us/our-work/key-statistics-incontinence#:~:text=Faecal%20incontinence%20affects%206%25%20of,the%20community%20are%20women2.
This feature was originally published in the March issue of Retail Pharmacy magazine.
