Comprehensive Insights into the Causes of Bowel Obstruction in Elderly Nursing Home Residents

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Comprehensive Insights into the Causes of Bowel Obstruction in Elderly Nursing Home Residents

Date: 29 September 2023 | Blog | Nursing Home Neglect | Bowel Blockage | By: Sanga Turnbull

Introduction

The complexities of bowel obstruction in the elderly population, specifically those residing in nursing homes, demand an in-depth understanding of the multiple causative factors.

Detailed Causes of Bowel Obstruction

Adhesions

Adhesions are fibrous bands of scar tissue that may form following abdominal or pelvic surgery. They can act like internal scarves, tying organs together and obstructing the natural flow of intestinal contents.

In the elderly, the chances of having undergone one or more types of abdominal surgeries—like appendectomies, hysterectomies, or gallbladder removal—over a lifetime are considerably higher. These adhesions can remain asymptomatic for years before triggering an obstruction.

Diverticular Disease

Diverticula are small pouches that can form in the walls of the colon. When these pouches become inflamed or infected, the condition is termed diverticulitis. The risk of developing diverticulitis increases with age. An inflamed diverticulum can narrow the passage within the colon, causing partial or full obstruction.

Hernias

Hernias occur when an organ or fatty tissue protrudes through a weak spot in the surrounding muscle or connective tissue.

In the elderly, muscle weakness due to aging or reduced physical activity can lead to hernias, including inguinal, umbilical, and incisional types. A hernia can obstruct the bowel if it becomes trapped (incarcerated) or strangulated.

Medication Side Effects

Certain medications, such as anticholinergics and opioids, are notorious for causing constipation. The elderly often have multiple comorbidities requiring polypharmacy, which increases the risk of drug-induced constipation and subsequently bowel obstruction.

Fecal Impaction

Fecal impaction occurs when a mass of hardened stool becomes lodged in the colon or rectum. Factors such as chronic constipation, use of medications like antipsychotics, and reduced fluid intake contribute to fecal impaction in nursing home residents.

Volvulus

A volvulus occurs when a portion of the intestine twists around itself and the mesentery that supports it. In the elderly, a lifetime of intestinal wear and tear, prior surgeries, or anatomical abnormalities can predispose them to volvulus formation, causing sudden and severe obstruction.

Inflammatory Bowel Diseases (IBD)

Conditions like Crohn's Disease and ulcerative colitis can lead to chronic inflammation of the intestines. While less common in the elderly, preexisting IBD can cause strictures, or narrowed passages, in the intestine, leading to obstruction.

Conclusion

In the setting of a nursing home, where patients are particularly vulnerable, a nuanced understanding of these causative factors is not just advisable but imperative for quality patient care. A family empowered to understand the different causes can alert nursing home staff to potential issues with their loved one.

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