Gastrointestinal Tract Disorders in the Elderly
Growing old has advantages and disadvantages. One simple advantage of growing old is having more time to relax and enjoy life. On the other side, a simple disadvantage is the increase in health challenges, gastrointestinal tract disorders being among them.
Gastrointestinal tract disorders can occur at any age; however, they are more common in adults. Common gastrointestinal tract disorders that come with ae include;
- Dysphagia – dysphagia is the term that describes difficulty swallowing. Dysphagia may be caused by degeneration of muscles and nerves, reduced production of saliva, reduced strength in the upper esophageal sphincter and impaired coordination of the process of swallowing.
As a person grows old, these symptoms become more frequent. Difficulty swallowing can be reduced through good dental health, eating slowly, thorough chewing, sitting upright when eating and using dentures that fit properly.
- Functional Dyspepsia – this is a chronic disorder of movement and sensation in the upper digestive tract. Symptoms of functional dyspepsia include bloating, belching, indigestion, upper abdominal pain that recurs, nausea and early fullness. It is not known what cause this disorder. However, food allergies, inflammation of the stomach or duodenum, psychological factors, side effects of some medicines and excessive secretion of acid are thought to trigger functional dyspepsia.
- Gastroesophageal reflux disease – also abbreviated as GERD. This disorder occurs in the upper digestive tract. It occurs when the upper digestive tract is not working properly and thus stomach contents flow back into the esophagus.
Acid reflux is the main symptom of GERD. Other symptoms of GERD include persistent sore throat, bad breath, heartburn, acid or food regurgitation, chronic coughing and chest pain.
Management of GERD and Dyspepsia
Management of GERD and dyspepsia is the same. Both require combining lifestyle and dietary modifications and sometimes may need medication. The first step is to identify foods that trigger symptoms or worsen them.
Foods that are likely to trigger GERD and FD include alcohol, caffeine, fatty foods and spicy foods. However, different foods affect people differently. Such foods should be avoided or consumed in less quantities to control symptoms.
In addition, reducing or quitting smoking cigarettes and maintaining a healthy weight can also help manage both disorders. Nicotine and being obese can cause the lower esophageal sphincter to not function as it should. It is also important to elevate the head while sleeping and to avoid sleeping immediately after eating.
Heartburn is reduced using medications that neutralize the acid such as Pepto-Bismol and Maalox which are used for a short period of time. The other type of medication used include histamoine-2 receptor antagonists and proton pump inhibitors. These drugs reduce heartburn by suppressing the secretion of acid.
- NSAID Complications – these are complications caused by non-steroidal anti-inflammatory drugs. These drugs are pain relievers such as ibuprofen and aspirin. These medications are effective pain relievers but damage the upper digestive tract. High doses and frequently using this medication can cause gastric ulcers as people age.
To avoid the damage that comes with the use of these medications, a person should take PP1s and H2RAs to reduce acid in the stomach or those that protect the stomach by acting as a mucosal shield.
- Bowel Habits – normal bowel habits differ from one person to another. While understanding bowel habits, the focus should be on understanding a person’s comfort level. Having a bowel movement 3 times a week or 3 times a day is pretty much considered normal. However, even if you are in this category and you experience unpleasant symptoms, it may not be healthy for you.
Those outside this range but with no symptoms are fine. A healthy bowel movement is one that passes smoothly, is not painful and should not be too hard and lumpy or too loose and watery.
In short, when you have a normal bowel movement, it should not be uncomfortably urgent nor should you have to strain when it’s time to go.
- Diarrhea – this occurs when the digestive tract pushes waste matter too quickly. What this ideally means is that the large intestine does not get enough time to adequately remove water out of the colon. This increases the volume, frequency and fluid of bowel movements.
Diarrhea is caused by many things; some causes are from chronic disease while others are temporary. Causes of diarrhea include celiac disease, inflammatory bowel disease, celiac disease, as a side effect of certain medications, infection and lactose intolerance.
Medications used to manage diarrhea can be classified into two. Bulk formers soak up water in the bowel to reduce stool frequency and looseness. Bulk formers include bile salt binders and psyllium or fibre.
The other type is those that change the muscle activity of the intestine which slows down transit time and allow the intestines to absorb more water from the stool. Examples of such medications are non-narcotic anti diarrheal agents, anti-spasmodic agents and loperamide.
- Constipation – constipation occurs when fecal matter takes longer than usual to move through the digestive tract. As a result, the large intestine absorbs excess water from stool. This results in dry and hard stool that has reduced frequency causing bloating straining, abdominal pain, rectal fullness or pressure and a feeling of incomplete evacuation of stool.
Symptoms of constipation cause back pain, general malaise and poor appetite. Constipation is caused by insufficient physical activity, irritable bowel syndrome, certain supplements, a diet that is too low in fluid and fibre, as a side effect of certain medications. Constipation is more common in older adults although it can affect anyone.
Dietary and lifestyle changes can help reduce cases of constipation. Drinking plenty of fluids and eating food rich in fibre can add bulk to the stool making it move more easily through the digestive tract.
Constipation can be treated using prunes. They are high in fibre and contain lots of nutrients. Exercising can also help move stool more quickly. Complications of constipation include hemorrhoids. Complications can be reduced by not straining and taking time in the bathroom.
In cases where lifestyle changes cannot help, there are lots of medications that can speed up transit time to prevent and relieve constipation. Lubricants, stool softeners, hyperosmotic and stimulants are examples of such medications. Enemas should only be used when recommended by a doctor.
Severe cases of constipation can be treated using linaclotide to improve stool consistency. This medicine works by increasing fluid secretion in the intestines.
- Diverticular disease – this disorder occurs when small sac-like pouchings balloon theough the outer wall of the colon to form in the lining of the colon. These pouchings may increase in size as time goes.
These pouchings mostly occur in the lower part of the colon. This particular disorder mostly affects the elderly.
Symptoms of this disorder include cramping, bloating, diarrhea, fever, intense pain and tenderness in the lower abdomen, bleeding and bowel irritability. It can be treated by taking a low-fibre or liquid diet to allow the bowel to rest, surgery when necessary and sometimes antibiotics.
- Colorectal cancer – this is a life-threatening disease. This disease is common among the elderly. It is also more common in women than women. Risk factors for colorectal cancer are a family history of colorectal cancer and people who have had Crohn’s disease or ulcerative colitis for more than 10 years.
Early diagnosis of colorectal cancer leads to extremely effective treatment. Colorectal cancer begins as a polyp and will take up to 10 years to develop into colorectal cancer. It is for this reason that doctors recommend a coloscopy every 10 years.
Doing coloscopy helps doctors to identify and remove any polyps before they develop into colorectal cancer. Annual stool check can also help diagnose colorectal cancer early enough. If the doctor identifies anything abnormal, they may recommend additional tests.
People experiencing significant health issues and those above 75 years can stop doing colon screening.
- Irritable bowel syndrome – this is a group of gastrointestinal conditions. They are characterized by cramps, bloating and frequent abdominal pain. Cramping may be linked to constipation and diarrhea.
Symptoms of irritable bowel syndrome vary in frequency and duration form one person to another. Treatment options for irritable bowel syndrome include:
- avoiding stress or learning how to cope with it
- avoiding carbohydrates that are poorly absorbed, ferment in the colon and are more prone to absorb water.
- eating a healthy diet with more or less fiber
- Lactose intolerance – a person with this disorder cannot fully digest lactose that is found in the milk of mammals. Lactose intolerance occurs due to low levels of the lactase enzyme that is responsible for digesting lactose.
Symptoms of lactose intolerance include gas, diarrhea, bloating and abdominal cramps. Symptoms vary from one person to another. Treatment for lactose intolerance involves taking enzyme supplements that can help break down lactose. Replacing regular milk with lactose free milk may also help.
- Peptic Ulcer disease – this is a gastrointestinal condition caused by Helicobacter pylori. This condition comes with open sores or ulcers in the inner lining of the duodenum and the stomach. The lining of the stomach is prevented from corrosion by digestive juices by a thick layer of mucus.
When a person has peptic ulcers, this protective layer is usually reduced. Reduction of the protective layer of mucus may also be caused by old age, long-term use of certain medications and alcoholism.
Symptoms of peptic ulcer disease include nausea, vomiting, bloating, acid reflux and burning sensation in the upper abdomen. Symptoms of severe PUD include heavy vomiting that may be tinged with blood, weight loss, tarry-black stool and severe pain in the upper abdomen.
Treatment options for peptic ulcer disease include prescription drugs and a healthy diet. In rare cases, surgical removal of the ulcers may be recommended.
- Gallstones – gallstones are lumps that look like stones that develop in the gall bladder or in the bile ducts. The exact cause for gallstones is not known. However, it is believed that gallstones occur when there is a high concentration of cholesterol and bilirubin in the bile.
Diagnosis of gallstones is done by endoscopy and ultrasound. Endoscopy is done to detect small gallstones.
In most cases, gallstones have no symptoms. However, people usually experience pain in the upper right abdomen especially after consuming fatty foods. Other symptoms may include nausea, vomiting, indigestion, burping, clay-colored stool and dark urine.
Treatment options for gallstones depends on the symptoms. In some cases, surgery may be necessary to remove gallstones. In cases where gallstones develop on the bile ducts, endoscopy may be done.
- Acute and Chronic Pancreatitis – pancreatitis is the inflammation of the pancreas. It can be either acute or chronic. Pancreatitis is the most common pancreatic disorder. It is a major cause of morbidity. Cases of pancreatitis have been on the rise. This is due to increased rates of gallstones and obesity.
Chronic pancreatitis is less common and occurs over months and years. Causes of pancreatitis include;
- abdominal injury
- smoking cigarettes
- cystic fibrosis
Symptoms of pancreatitis usually start suddenly and are characterized by nausea, abdominal pain that worsens with eating and may extend to the back and vomiting. Complications that may arise from acute pancreatitis include diabetes, kidney failure, pseudocyst and necrotizing pancreatitis.
Chronic pancreatitis may lead to oily stools and involuntary weight loss. Diagnosis of pancreatitis is done through blood tests that are done to measure the level of pancreatic enzymes.
Ultrasounds and a CT scan may also be done. Gene tests can also be done for rare genetic forms of chronic pancreatitis. Treatment for pancreatitis is done at the hospital and may need hospitalization. Treatment will include pain medication, fasting and infusion of IV fluids.
- Liver disease – the liver plays a key role in digestion. For instance, it stores energy, breaks down food and gets rid of toxins from the blood. Liver disease is a term used to refer to all digestive conditions that affect the liver.
Causes of liver disease may differ from one person to another. Causes of liver disease usually affect how the liver functions. Liver disease can be diagnosed with a blood test done by the primary care giver or the gastroenterologist. It can also be diagnosed using CT scans and MRIs.
Symptoms of liver disease vary depending on the cause from one person to the other. General symptoms of liver disease are persistent fatigue, swollen legs, ankles, abdomen, dark urine, jaundice, itchy skin, black or bloody stool and loss of appetite.
Treatment of liver disease involves lifestyle changes such as reducing alcohol consumption, drinking plenty of water, maintaining a healthy weight and maintaining a diet that is low in fats.
Treatment options will depend on the underlying cause. In some cases, the doctor will prescribe blood pressure drugs, steroids, antibiotics, multivitamins and antiviral drugs. In rare cases, surgery might be necessary to remove the diseased/damaged part of the liver. In cases where there is no other viable treatment options, the doctor may consider liver transplant.
warning signs of gastrointestinal tract disorders
If a person experiences the following symptoms, they should see the doctor;
- bleeding/ anaemia
- family/personal history of colon cancer
- unplanned weight loss
- nocturnal bowel movements
How to protect the digestive system as we age
Prevention of gastrointestinal tract disorders is necessary. The following tips can help protect the digestive tract and help maintain smooth running of digestion;
- Checking your medications – all medications should be used with care. It is important to talk to the doctor if you suspect that your medications are causing digestive symptoms and problems. For instance, people who use NSAIDs for pain should talk to their doctor to find the lowest effective dose of the same. They should also ensure they take them with food. Lastly, it is important to talk to your doctor to make sure that you are only taking the medications you need.
- Stay active – 30 minutes of physical activity on a daily basis for atleast 5 days in a week can help prevent most of the problems related to age. Exercising may also reduce the risk for colon cancer.
- Eating more fibre -foods such as whole grains, vegetables, fruits and beans are high in fibre and nutrients and are low in fat. These foods can help prevent constipation and reduce symptoms of diverticulosis.
- drinking plenty of fluids – it is important to drink enough fluids throughout the day. Drinking enough fluids prevents feeling thirsty. People who are taking diuretics should talk to their doctors about helpful ways of managing how they should take their medication to avoid becoming dehydrated.
- Managing your weight – maintaining a healthy weight helps prevent health problems related to old age such as high blood pressure, heart disease and diabetes. Maintaining a healthy weight helps to avoid health problems which then reduces the number of medications a person has to take which can cause digestive side effects and possibly cause gastrointestinal tract disorders.
Managing weight is easy if one limits the amount of fat in their diet, choose whole foods instead of processed foods and choosing healthy portions.
- Get regular health screenings – regular screening is important. Talk to you doctor about any worrying symptoms and enquire on regular screening.
The risk for developing digestive disorders and diseases increase as a person ages. However, they can be easily avoided by eating a well-balanced diet, exercising regularly and seeing the doctor as soon as you notice any abrupt changes in the digestive system can go along way in helping you maintain a healthy digestive tract.