Constipation in the older adult
- Satish SC Rao, MD, PhD, FRCP
Satish SC Rao, MD, PhD, FRCP
- Chief, Gastroenterology/Hepatology
- Georgia Regents University
- Section Editors
- Nicholas J Talley, MD, PhD
Nicholas J Talley, MD, PhD
- Section Editor — Motility Disorders
- Professor of Medicine, University of Newcastle, Australia
- Adjunct Professor of Medicine and Epidemiology and Consultant, Mayo Clinic, Rochester, MN
- Adjunct Professor, University of North Carolina
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Constipation is a common complaint in older adults. It has a major impact on healthcare costs in the United States because it results in several office visits, specialty referrals, hospital admissions, and surgical procedures. It also affects health-related quality of life [1,2].
This topic will review the clinical approach to the diagnosis and management of constipation in the older adult. The approach to diagnosis and management of constipation in children and adults in general are presented separately. (See "Constipation in infants and children: Evaluation" and "Chronic functional constipation and fecal incontinence in infants and children: Treatment" and "Etiology and evaluation of chronic constipation in adults" and "Management of chronic constipation in adults".)
DEFINITION OF CONSTIPATION
The term constipation is variably defined by patients and physicians .
According to the Rome III criteria, functional constipation is defined as any two of the following features: straining, lumpy hard stools, sensation of incomplete evacuation, use of digital maneuvers, sensation of anorectal obstruction or blockage with 25 percent of bowel movements, and decrease in stool frequency (less than three bowel movements per week). The above criteria must be fulfilled for the last three months with symptom onset six months prior to diagnosis, loose stools should rarely be present without the use of laxatives, and there must be insufficient criteria for a diagnosis of irritable bowel syndrome.
EPIDEMIOLOGY AND RISK FACTORS
Studies have reported that the prevalence of constipation in the older adult ranges from 24 to 50 percent [4-12]. Laxatives are used daily by 10 and 18 percent of community dwelling older adults and 74 percent of nursing home residents [9,13-16].
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- DEFINITION OF CONSTIPATION
- EPIDEMIOLOGY AND RISK FACTORS
- Primary colorectal dysfunction
- - Slow transit constipation
- - Dyssynergic defecation
- - Irritable bowel syndrome
- Secondary causes for constipation
- Chronic idiopathic constipation
- CLINICAL MANIFESTATIONS
- Physical examination
- Laboratory testing
- Physiologic testing
- Lifestyle modification
- Diet and fiber
- - Bulk forming laxatives
- - Osmotic laxatives
- - Stimulant laxatives
- Stool softeners, suppositories, and enemas
- Other therapies for chronic constipation
- - Colonic secretagogues
- - Opioid antagonists
- - 5HT(4) receptor agonists
- FECAL IMPACTION
- SUMMARY AND RECOMMENDATIONS