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Constipation and Fecal Incontinence in the Elderly

  • Gastroenterology in Geriatric Patients (Sita Chokhavatia)
  • Published:
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Abstract

Purpose of Review

To review the epidemiology, pathogenesis, clinical features, and management of primary constipation and fecal incontinence in the elderly.

Recent Findings

Among elderly people, 6.5%, 1.7%, and 1.1% have functional constipation, constipation-predominant IBS, and opioid-induced constipation. In elderly people, the number of colonic enteric neurons and smooth muscle functions is preserved; decreased cholinergic function with unopposed nitrergic relaxation may explain colonic motor dysfunction. Less physical activity or dietary fiber intake and postmenopausal hormonal therapy are risk factors for fecal incontinence in elderly people. Two thirds of patients with fecal incontinence respond to biofeedback therapy. Used in combination, loperamide and biofeedback therapy are more effective than placebo, education, and biofeedback therapy. Vaginal or anal insert devices are another option.

Summary

In the elderly, constipation and fecal incontinence are common and often distressing symptoms that can often be managed by addressing bowel disturbances. Selected diagnostic tests, prescription medications, and, infrequently, surgical options should be considered when necessary.

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Correspondence to Adil E. Bharucha.

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Dr. Bharucha has a patented anorectal manometry device with royalties paid to Medspira Inc, a patented anorectal catheter fixation clip pending to Medtronic, and a patented anal insert device for fecal incontinence pending to Minnesota Medical Technologies. The other authors declare that they have no competing interests.

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Deb, B., Prichard, D.O. & Bharucha, A.E. Constipation and Fecal Incontinence in the Elderly. Curr Gastroenterol Rep 22, 54 (2020). https://doi.org/10.1007/s11894-020-00791-1

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