Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 484

Healthy ageing is associated with a linear reduction in strength of voluntary anal squeeze from the seventh decade in women and the ninth in men,¹⁶ and rectal sensation may also decrease with age with a rise in anorectal sensitivity thresholds.¹⁷ Imaging studies suggest that the anal sphincter decreases in thickness with age,¹⁸ but the functional significance of this change is unknown. Rectal sensory thresholds may also decrease with ageing in healthy older adults without associated changes in compliance or tone,¹⁹ with 30% fewer enteric neurons and greater fatty tissue deposition in those over 65 compared to those under 30.²⁰ These changes may impair the ability to distinguish stool from flatus. Although not measured in clinical practice, there is an increase in pudendal nerve latency in older women,¹⁹ and it is unclear if rectal motility is affected by normal ageing.²¹ Studies in older people suggest that both antibiotic use and diet affect the microbiome and metabolome²² and that the frail and those living in institutions have less diverse microbiota than community‐dwelling older people.²³ The extent to which these changes influence faecal incontinence or can guide therapeutic interventions is unknown and represents a significant gap and opportunity in the research base.