For the prevention of hemorrhoids, a balanced diet is important, but this does not always lead to daily bowel movements. Even if elderly persons think that they are taking a balanced diet consistent with that which they had when they were young, they actually eat less as they age and as a result they have fewer feces and less frequent bowel movements. Intestinal motility, body movements and such will decrease with aging. If an elderly patient complains of constipation despite having a balanced diet, I advise the patient that "this is not constipation but is a normal body condition of patients your age." Such advice is also important in terms of patient education.
It is also important to devise ways of providing treatment according to the patient's age, such as anoplasty for elderly patients with lower anal pressures to slightly narrow the anal canal.
A tear in the lining of the anus (anal fissure) commonly occurs in children with constipation when they pass hard stools. Infants or children with anal fissure do not want to pass stools due to pain, which leads to fecal loading or impaction in the intestine and makes stools even harder. This will result in a vicious cycle of constipation. In such a case, abdominal pain may occur in addition to anal pain. Caution must be exercised.
Hemorrhoids and various other perianal problems may occur in the elderly. "Rectal prolapse" is one of such conditions in which the rectum protrudes from the anus. This disease is thought to be caused by loosening of the anal sphincter and such. In some cases, about 5 cm to 30 cm (in severe cases) of the rectum is prolapsed. Although it does not hurt, some patients with rectal prolapse visit our hospital because they notice something sticking out of the anus or their undergarments get soiled with blood or mucus, and some patients complain that the prolapsed rectum interferes with their walking. In addition, elderly patients with rectal prolapse may not be admitted to some facilities for the aged, so they said that they wanted to have rectal prolapse cured to be admitted to such facilities.
In general, hemorrhoids (piles) and anal fissure are less painful for elderly patients. Many elderly patients present with the following complaints: "feeling uncomfortable due to prolapsed hemorrhoids (piles)," "pressing on hemorrhoids (piles) while sitting" and "soiling with blood." This is said to be related to the pressure in the anal canal. It is considered to become difficult for elderly patients to feel anal pain due to decreased anal canal pressure.
"Infantile anal fistula" may occur in infants. This condition requires no treatment, spontaneously resolving in many cases. For children still suffering anal fistula until the age of around 12 years, surgery will be considered when their body becomes large enough. There are also many children with "anal fissure" due to constipation; such patients are often treated with laxatives or enema at a pediatric clinic. For children with constipation, it is most important to use drugs appropriately to form the habit of smoothly passing stools spontaneously once daily.
