//fpnotebook.com/
Constipation Causes in the Elderly
Aka: Constipation Causes in the Elderly, Constipation in Older Adults
- See Also
- Constipation
- Constipation Causes
- Organic Constipation
- Functional Constipation
- Drug-Induced Constipation
- Epidemiology: Prevalence
- Constipation in Adults over age 60 years: 33%
- Constipation in Nursing Home residents: >50%
- Pathophysiology: Types
- Normal Transit Constipation (most common)
- Normal stool frequency, but hard consistency
- Slow Transit Constipation
- Bowel Myopathy or Neuropathy
- Infrequent Defecation with bloating and Abdominal Pain
- Disorders of Defecation (common in elderly)
- Decreased rectal smooth Muscle Contraction or relaxation
- Decreased stooling urge response to rectal Sensation of Stretching
- Consult gastroenterology
- Symptoms
- Straining during Defecation
- Difficult stool evacuation
- Intermittent paradoxical Diarrhea
- Liquid stool leaks around impacted stool
- Risk Factors
- Dehydration
- Immobility (especially with Arthritis)
- Causes
- Consider Constipation red flags (high risk population for Colon Cancer)
- See Constipation Causes
- See Organic Constipation
- Functional causes
- Rectal Outlet Constipation
- Secondary Constipation
- See Secondary Constipation
- Autonomic Neuropathy
- Diabetes Mellitus
- Parkinson Disease
- Other neurologic disorders
- Dementia
- Decreased Sensation to defecate (risk for impaction)
- Spinal cord disorders
- Medications
- See Drug-Induced Constipation
- Opioids (see Opioid-Induced Constipation)
- Anticholinergic Medications
- Management
- See Constipation Management
- Constipation due to disorders of Defecation should be referred to Gastroenterology
- Goals
- Clear Fecal Impaction first
- Improve symptoms (bloating, pain)
- Soft, formed stool without straining 3 times weekly or more
- Behavioral measures
- Straighten anorectal junction by placing feet on step stool while sitting on toilet
- Allow patient time and privacy to stool without interruption
- Encourage adequate hydration (48 to 64 ounces or 1.5 to 2 Liters daily)
- Encourage adequate fiber intake such as Metamucil or Citrucel (20-35 g/day)
- See Dietary Fiber
- Delay start until Acute Constipation has resolved and hydration is adequate
- Gradually increase over the course of weeks and decrease if cramps, bloating occur
- Biofeedback
- Pelvic Floor Exercises
- Retrain DefecationMuscles
- Ineffective measures
- Probiotics are not effective
- Chmielewska (2010) World J Gastroenterol 16(1): 69-75 [PubMed]
- Disimpaction
- Perform rectal exam to confirm no firm impaction resulting in obstruction
- Manually disimpact first
- Preferred options
- Mineral Oil enemas
- Tap water enema
- Glycerin suppository
- Avoid measures with adverse effects in older adults
- Phosphate enemas such as Fleets Enema (risk of Electrolyte abnormalities)
- Soap sud enema (risk of rectal mucosa injury)
- Laxatives
- Bulk Laxatives
- See fiber above under behavioral measures
- Osomotic Laxatives
- Polyethylene glycol (Miralax, PEG Solution) 1/2 to 1 capful daily in 4-8 ounces juice
- Exercise caution with Magnesium salts (e.g. Magnesium Citrate)
- Risk of Magnesium toxicity (and ileus)
- Consider single Magnesium Citrate 150-300 ml use after initial disimpaction
- Stool Softeners
- DocusateSodium (Colace) 100 mg orally twice daily (or 200 mg at night)
- Effective in older adults, despite underwhelming effects in other populations
- Stimulant Laxatives
- Senna 15 mg daily or Bisacodyl (Dulcolax) 5-15 mg daily
- Longterm Stimulant Laxative use is not recommended (unless refractory to other measures)
- Other agents for refractory Constipation (expensive)
- See Opioid-Induced Constipation
- Lubiprostone (Amitiza) 24 mcg twice daily (Nausea in 18%)
- Linaclotide (Linzess) 145 mcg daily (Diarrhea in 16%)
- References
- Mounsey (2015) Am Fam Physician 92(6): 500-4 [PubMed]
- Fleming (2010) Am J Geriatr Pharmacother 8(6): 514-50 [PubMed]