Digestive Transit


With age, digestive health disorders may arise due to age-related disease, malnutrition or polypharmacy.
In fact, nearly 40% of older adults have one or more age-related digestive disorders each year.
The most common digestive health problems are constipation and diarrhea, which can be prevented and managed by dietary changes.
Constipation is a common gastrointestinal problem; it can be defined as infrequent bowel movements or the difficult passage of stools. Most cases of constipation are temporary.
Constipation most commonly occurs when stool moves too slowly through the digestive tract, causing it to become hard and dry. Normally, the waste products of digestion (stool) are propelled through the intestines by muscle contractions. Constipation occurs when there is not enough fluid or fibre-rich food in the patient’s diet, or if the colon’s muscle contractions are slow or not properly coordinated.
It is reported that the prevalence of constipation increases with age, especially in people over the age of 65. 1

  • 50% of the elderly living in the community experience constipation2
  • This number is even higher in nursing home residents, with 74% using daily laxatives24
  • Elderly women are 2 to 3 times more likely to report constipation than their male counterparts2
  • Constipation is also more commonly seen in patients taking multiple medications5

In addition, constipation is a significant driver of health care costs, as it is ranked among physicians’ top 5 most common diagnoses for gastrointestinal outpatient visits.2 The management of constipation is estimated to cost on average $200 per year and per patient within a large HMO (Health Maintenance Organization).6

Causes

A number of factors can increase the risk of constipation, including:

  • Aging
  • Insufficient fluid intake or dehydration
  • Insufficient amount of fibre in the patient’s diet (i.e. vegetables, fruit, cereals…)
  • Inappropriate bowel habits
  • Poor mobility or lack of physical activity
  • Frequent use or misuse of laxatives
  • Illness and specific diseases, such as stroke, diabetes, thyroid disease, irritable bowel syndrome and Parkinson’s disease
  • Side effects of certain medications, including pain, high blood pressure and depression medications, diuretics and those used to treat Parkinson’s disease
  • Change in routine, lifestyle or eating habits
  • Anxiety or depression

How to prevent and treat constipation?

Elderly patients require an individualized approach for the treatment of constipation. Simple changes in diet and lifestyle can help relieve symptoms and manage constipation.  Medical treatment should be considered only when diet and lifestyle changes aren’t effective.

  • Diet and lifestyle changes:
    • A high-fibre diet with at least 20 to 35 grams of fibre each day helps the body form soft, bulky stools. Previous studies have shown that a high fibre diet increases stool weight and decreases colon transit time, while a low fibre diet leads to constipation7,8. For older people who experience difficulties in eating fibre-rich food such as vegetables or cereal products, the use of fibre-enriched food supplements can be useful in ensuring a proper amount of fiber in the diet.
    • Regular exercise. Physical activity can help stimulate intestinal activity.
    • Adequate fluid intake. Drinking plenty of water and other fluids will help to form soften stools.
    • Taking time for bowel movements. The patient should set aside sufficient time to allow undisturbed visits to the toilet.
    • Dietary supplements as prebiotics (non-digestible food ingredients that stimulate the growth and/or activity of bacteria in the digestive system), probiotics (live bacteria) or symbiotics (especial mixtures of pre and probiotics) have shown to improve constipation symptoms by changing microbiota composition.
  • Laxatives
  • Treating underlying causes

Laboratoires Grand Fontaine offers a complete range of nutritional options adapted to the patient’s condition:

References
1 Rao SS. Constipation: Evaluation and treatment of colonic and anorectal motility disorders. Gastroenterology Clinics of North America. 2007;36(3):687, 711, x.
2 Bouras EP, Tangalos EG. Chronic constipation in the elderly. Gastroenterology Clinics of North America. 2009;38(3):463–480.
3 Harari D, Gurwitz JH, Avorn J, et al. Constipation: Assessment and management in an institutionalized elderly population. Journal of the American Geriatrics Society. 1994;42(9):947–952.
4 Primrose WR, Capewell AE, Simpson GK, et al. Prescribing patterns observed in registered nursing homes and long-stay geriatric wards. Age Ageing. 1987;16(1):25–28.
5 Whitehead WE, Drinkwater D, Cheskin LJ, et al. Constipation in the elderly living at home. definition, prevalence, and relationship to lifestyle and health status. Journal of the American Geriatrics Society. 1989;37(5):423–429.
6 Singh G, Lingala V, Wang H, et al. Use of health care resources and cost of care for adults with constipation. Clinical Gastroenterology and Hepatology.  2007;5(9):1053–1058.
7 Tucker DM, Sandstead HH, Logan GM, Jr, et al. Dietary fiber and personality factors as determinants of stool output. Gastroenterology. 1981;81(5):879–883.
8 Burkitt DP, Walker AR, Painter NS. Effect of dietary fibre on stools and the transit-times, and its role in the causation of disease. Lancet. 1972;2(7792):1408–1412.

The World Health Organization describes diarrhea as the passage of 3 or more loose or liquid stools per day, or more frequently than normal for the individual. Diarrhea occurs when the food and fluids ingested pass too quickly or in too large an amount — or both — through the colon. Normally, the colon absorbs liquids from the food, leaving a semisolid stool. If liquids from the foods aren’t absorbed, the bowel movement is watery.
In most cases, diarrhea signs and symptoms usually last a couple of days. But sometimes diarrhea can last for weeks. In these situations, diarrhea can be a sign of a serious disorder, such as inflammatory bowel disease.
In the United States, adults suffer on average one acute case of diarrhea each year.1 Disease prevalence increases with age, the severity of disability, malnutrition, impaired immunity and medication. For the elderly, diarrhea can have serious consequences on health, especially dehydration, and on quality of life.

The most common causes of diarrhea include the following:

  • Excessive use of laxatives, frequent in elderly people
  • Medication: antibiotics, cancer drugs, and antacids containing magnesium. Antibiotics destroy both good and bad bacteria, which can disturb the natural balance of bacteria in the intestine (microbiota).
  • Bacterial infections, viral infections or parasites.
  • Functional bowel disorders and intestinal diseases: irritable bowel syndrome, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, etc.
  • Malabsorption syndromes (p.e. short bowel syndrome).
  • Food intolerances and sensitivities. Some people have difficulty digesting certain ingredients, such as:
    • Lactose, the sugar found in milk and dairy products: lactose intolerance.
    • Fructose, a sugar found naturally in fruits and honey and added as a sweetener to some beverages: fructose intolerance.
    • Gluten, a protein found in cereal products: celiac disease.
  • Surgery

Symptoms

Symptoms associated with uncomplicated diarrhea may include:

  • Abdominal bloating or cramps
  • Frequent, loose or watery stools
  • A sense of urgency to have a bowel movement
  • Nausea and vomiting

In addition to the symptoms described above, symptoms associated with complicated diarrhea may include:

  • Blood, mucus, or undigested food in the stool
  • Weight loss
  • Fever
  • Dehydration

How to prevent and treat diarrhea?

The most severe threat posed by diarrhea is dehydration, which occurs when loss of water and electrolytes is not replaced. Dehydration must be treated promptly to avoid serious health problems.
There are different ways to manage diarrhea depending on its severity:

  • Rehydration to avoid or treat dehydration associated with diarrhea:
    • Drink water but also liquids containing minerals, such as sodium and potassium, which the patient needs (eg. fruit juices).
    • Use of oral rehydration solutions.
    • In the case of severe dehydration, intravenous fluids can be used.
  • Dietary management:
    • Avoid certain foods such as dairy products, fatty foods, high-fibre foods or highly seasoned food
    • Use zinc supplements which reduce the duration and frequency of  diarrhea episode
    • Eat nutrient-rich foods: the vicious circle of malnutrition and diarrhea can be broken by continuing to give nutrient-rich foods during an episode, and by giving a nutritious diet to adults when they are well
    • Dietary supplements as prebiotics (non-digestible food ingredients that stimulate the growth and/or activity of bacteria in the digestive system), probiotics (live bacteria) or symbiotics (especial mixtures of pre and probiotics) have shown to reduce the duration of diarrhea. They also are useful helping to restore the microbiota balance that has been damaged by the diarrheal process.
  • Medical management:
    • Adjust medication if it is causing diarrhea
    • Treat underlying conditions if diarrhea is caused by a more serious disease or condition, such as inflammatory bowel disease
    • Antibiotics or anti-diarrheal medication

Laboratoires Grand Fontaine offers a complete range of nutritional options adapted to the patient’s condition:

References
1DuPont HL. Practice Parameters Committee of the American College of Gastroenterology. Guidelines on acute infectious diarrhea in adults. The American Journal of Gastroenterology. 1997;92(11):1962–1975.

Microbiota is the beneficial bacteria in the human bowel needed to aid digestion and support the immune system. Sometimes it may be altered due to the use of certain drugs, especially antibiotics, causing undesirable side effects.

The elderly: population at risk of adverse effects

Elderly patients often have multiple chronic disorders and receive numerous medications:
   – In the U.S. 90% of non-institutionalized adults aged 65 or older use at least 1 medication per week1.
   – More than 40% of this population use 5 or more different medications per week.

Antibiotics are among the most frequently prescribed medications in modern medicine. Adding an antibiotic to the patient’s regimen (antibiotherapy) poses a further risk of side effects, drug-drug interaction and alteration of intestinal microbiota.
Although antibiotics have many beneficial effects, their misuse or polypharmacy use can have side effects on patient health and more specifically on their digestive transit. Polypharmacy (ie. the use of multiple medications and/or the administration of more medications than are clinically indicated) is common among the elderly.

The most common side effects of antibiotics affect the digestive system:

  • Alterations of intestinal microflora
  • Feeling or being sick
  • Diarrhea
  • Bloating and indigestion
  • Abdominal pain
  • Loss of appetite, anorexia

How to restore microbiota?

Antibiotics work by killing the harmful bacteria in the patient’s body, but they also kill beneficial bacteria needed to aid digestion and support the immune system. The patient’s diet during the illness should be adapted to restore healthy intestinal microbiota.
Dietary management should be based on probiotics and prebiotics. Probiotics are living beneficial bacteria that naturally colonize the intestine. They promote good digestion, boost the immune function, thus increasing resistance to infections, and inhibit the growth of harmful bacteria. Probiotics are naturally present in fermented foods such as yoghurt.
Prebiotics are non-digestible foods that promote the growth and activity of probiotics. Prebiotics are naturally present in high fibre content foods such as cereals, fruit and vegetables. Symbiotics are foods fortified with both prebiotics and probiotics.

Laboratoires Grand Fontaine offers a complete range of nutritional options adapted to the patient’s condition:

Reference:
1 Gurwith JH. Polypharmacy: A new paradigm or quality drug therapy in the elderly? Archives of internal medicine. 2004;64(18):1957-1859.

Food for special medical purposes.
Use under medical supervision.