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老年人便秘怎么办?老年人便秘的原因

发布时间:2016-05-09   问大夫  责任编辑:红豆

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老年人肠胃功能逐渐减弱,容易便秘,还常并发痔疮、肛裂、直肠脱垂等,严重的甚至会诱发大肠癌。同时,便秘也可能加重三高老人的病情。老年人便秘怎么办?老年人便秘的原因又有哪些?下面小编来为你介绍。

老年人便秘

老年人便秘(senile constipation)是指排便次数减少,同时排便困难,粪便干结。正常人每天排便12次或23天排便1次,便秘患者每周排便少于2次,并且排便费力,粪质硬结,量少,便秘是老年人常见的症状,约1/3的老年人出现便秘,严重影响老年人的生活质量。

老年人便秘的症状体征

便秘的主要表现是排便次数减少和排便困难,许多患者的排便次数每周少于2次,严重者长达24周才排便1次,然而,便次减少还不是便秘惟一或必备的表现,有的患者可突出地表现为排便困难,排便时间可长达30min以上,或每天排便多次,但排出困难,粪便硬结如羊粪状,且数量很少,此外有腹胀,食纳减少,以及服用泻药不当引起排便前腹痛,体检左下腹有存粪的肠襻,肛诊有粪块。

便秘可能是惟一的临床表现,也可能是某种疾病的症状之一,对于便秘患者,应了解病史,体格检查,必要时做进一步的检查,以明确是否存在消化道机械性梗阻,有无动力障碍。

体格检查能发现便秘存在的一些证据,如腹部有无扩张的肠型,是否可触及存粪的肠襻,进行肛门和直肠检查,可发现有无直肠脱垂,肛裂疼痛,肛管狭窄,有无嵌塞的粪便,还可估计静息时和用力排便时肛管张力的变化。


老年人便秘的原因

一、与年龄有关(15%):

老年人便秘的患病率较青壮年明显增高,主要是由于随着年龄增加,老年人的食量和体力活动明显少,胃肠道分泌消化液减少,肠管的张力和蠕动减弱,腹腔及盆底肌肉乏力,肛门内外括约肌减弱,胃结肠反射减弱,直肠敏感性下降,使食物在肠内停留过久,水分过度吸收引起便秘。此外,高年老人常因老年性痴呆或精神抑郁症而失去排便反射,引起便秘。

二、不良生活习惯(30%):

1、饮食因素

老年人牙齿脱落,喜吃低渣精细的食物,或少数病人图方便省事,饮食简单,缺粗纤维,使粪便体积缩小,黏滞度增加,在肠内运动减慢,水分过度吸收而致便秘。此外,老年人由于进食少,食物含热卡低,胃肠通过时间减慢,亦可引起便秘。有报道显示,胃结肠反射与进食的量有关,1000cal膳食可刺激结肠运动,350cal则无此作用。脂肪是刺激反射的主要食物,蛋白质则无此作用。

2、排便习惯

有些老年人没有养成定时排便的习惯,常常忽视正常的便意,致使排便反射受到抑制而引起便秘。

3、活动减少

老年人由于某些疾病和肥胖因素,致使活动减少,特别是因病卧床或坐轮椅的患者,因缺少运动性刺激以推动粪便的运动,往往易患便秘。

三、精神心理因素(35%):

患抑郁、焦虑、强迫症等心理障碍者易出现便秘,据Merkel等研究表明,1/3便秘患者抑郁、焦虑方面的评分明显增高。

1、肠道病变

肠道的病变有炎症性肠病、肿瘤、疝、直肠脱垂等,此类病变导致功能性出口梗阻引起排便障碍。

2、全身性病变

全身性疾病有糖尿病、尿毒症、脑血管意外、帕金森病等。

3、医源性(滥用泻药)

由于长期适用泻剂,尤其是刺激性泻剂,可因损伤结、直肠肌而产生导泻的结肠,造成肠道黏膜神经的损害,降低肠道肌肉张力,反而导致严重便秘。此外,引起便秘的其他药物还有如鸦片类镇痛药、抗胆碱类药、抗抑郁药、钙离子拮抗剂、利尿剂等。

正常排便包括产生便意和排便动作两个过程。进餐后通过胃结肠反射,结肠运动增强,粪便向结肠远端推进。直肠被充盈时,肛门内括约肌松弛,同时,肛门外括约肌收缩,使直肠腔内压升高,压力刺激超过阈值时即引起便意。这种便意的冲动沿盆神经、腹下神经传至腰骶部脊髓的排便中枢,再上行经丘脑到达大脑皮质。如条件允许,耻骨直肠肌和肛门内、外括约肌均松弛,两侧肛提肌收缩,腹肌和膈肌也协调收缩,腹压增高,促使粪便排出。老年人这组肌肉静息压普遍降低,黏膜弹性也减弱,甚至肛门周围的感受器的敏感性和反应性均有下降,使粪便易堆积于壶腹部而无力排出。老年人脑血管硬化容易产生大脑皮质抑制,胃结肠反射减慢,容易产生便秘。新近的研究表明,血胃肠激素参与控制结肠的动力,如血管活性肠肽、血浆胰多肽、胃动素、生长激素、缩胆囊素。激素的改变可能在老年人便秘发生中起来重的作用。


老年人便秘怎么办?

一、饮食

1、增加纤维素和水分的摄入

增加纤维素和水分的摄入,推荐每日摄入膳食纤维25-35g,每日至少饮水1.5-2.0L

2、适量摄入橄榄油

很多老人都是高血糖、高血脂、高血压人群,所以饮食都比较清淡,这也是导致便秘的原因之一,因为人体也需要油脂的润滑。建议在饮食中加入橄榄油,既能直接润肠,分解产物还能激肠蠕动,改善便秘症状。

二、运动

三、排便习惯

不要长时间坐着看电视或打麻将,坚持早晚散步有益于结肠张力的恢复。

另外,深呼吸对肠道也可起到自我按摩的作用,可提高结肠的张力,增加肠蠕动。

结肠活动在早上刚醒来和吃完饭后最为活跃,因此建议在晨起或餐后2小时内尝试排便,排便时一定要集中注意力,减少外界因素的干扰,不要看报纸或思考过多的事情。

但是有一点要注意,患有高血压等病症的老人在排便时不宜用力过猛,否则有可能引发脑血栓。

四、按摩穴位

1、按肚子——大巨穴

大巨穴是位于下腹部脐下三横指,前正中线旁开三横指处的两个对称的穴位,按摩有助于缓解便秘。

按摩时,可以仰卧,屈膝。两手中指分别按同侧的穴位,一边鼓肚子一边按压。做5-6次。

2、按脚底——太白穴

按摩足部内侧,第一跖趾关节内侧隆起部位后下方的太白穴,也有助于缓解便秘。

按摩时,将一条腿伸直坐下,把对侧脚搭在伸直腿的膝盖上,一只手固定踝部,另一只手用拇指以太白穴为中心从足尖向脚踝慢慢地平推。每侧做5-6次。

特别提醒:如果便秘时间持续较长或者症状比较严重,请尽快到医院就医并在专业医生的指导下进行治疗,以免延误病情。

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