Drugs & Aging

, Volume 21, Issue 14, pp 911–930 | Cite as

The Treatment of Chronic Constipation in Elderly People

An Update
  • Wanda Bosshard
  • Rebecca Dreher
  • Jean-François Schnegg
  • Christophe J. Büla
Review Article


Constipation is a common problem in elderly persons, with prevalence ranging from 15% to 20% in the community-dwelling elderly population and up to 50% in some studies of nursing home residents. In these patients, constipation results from a combination of risk factors, such as reduced fibre and fluid intake, decreased physical activity resulting from chronic diseases and multiple medications. Despite the high prevalence of constipation, there is surprisingly little evidence available on which to base management decisions of this common condition.

Increased fluid intake, regular physical activity and high fibre intake are usually proposed as first step nonpharmacological measures. However, adherence to these measures is limited and pharmacological treatment is frequently required. Data are too limited, especially in elderly persons, to formally recommend one class of laxatives over another or one agent over another within each class. However, bulk-forming and osmotic laxatives are usually recommended as first-line agents, even though data on their effectiveness are limited. The need to maintain good hydration is a limitation in the use of bulk-forming laxatives, in particular, in frail elderly patients. In these patients, polyethylene glycol, an osmotic agent, is an attractive alternative. In addition, it has been shown to relieve faecal impaction in frail patients with neurological disease. Its cost and potential danger in patients at high risk for aspiration is, however, a limitation. Stimulant laxatives are considered mainly as an intermittent treatment in patients who do not respond to bulk-forming or osmotic laxatives.

Several promising compounds such as the new serotonin 5-HT4 receptor agonists (tegaserod, prucalopride) and neurotrophin-3 (NT3) have not been adequately tested in older individuals. They are not routinely used and their role in the management of constipation in these patients will be more precisely defined in the future. Other treatment options are available (acupuncture, biofeedback, botulinum toxin and surgery), but experience with these interventions in elderly patients is limited and their indications in this population remain to be clarified.

Management of constipation in elderly persons depends largely on experience and beliefs. Several new compounds seem promising but will need to be specifically tested in this population before being recommended.



Dr Bosshard, Dr Dreher, Dr Schnegg and Dr Büla declare no conflict of interest relevant to the contents of the review.

The authors gratefully acknowledge the contribution of John C Beck, MD who reviewed earlier versions of the manuscript and Nadine Corbaz for secretarial assistance.

The authors have provided no information on sources of funding directly relevant to the content of this review.


  1. 1.
    Wanitschke R, Goerg KJ, Loew D. Differential therapy of constipation: a review. Int J Clin Pharmacol Ther 2003 Jan; 41(1): 14–21PubMedGoogle Scholar
  2. 2.
    Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care. Dig Dis Sci 1987 Aug; 32(8): 841–5PubMedCrossRefGoogle Scholar
  3. 3.
    Harari D, Gurwitz JH, Avorn J, et al. Constipation: assessment and management in an institutionalized elderly population. J Am Geriatr Soc 1994 Sep; 42(9): 947–52PubMedGoogle Scholar
  4. 4.
    Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut 1999 Sep; 45Suppl. 2: II43–7PubMedCrossRefGoogle Scholar
  5. 5.
    Stewart WF, Liberman JN, Sandler RS, et al. Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol 1999 Dec; 94(12): 3530–40PubMedCrossRefGoogle Scholar
  6. 6.
    Talley NJ, Weaver AL, Zinsmeister AR, et al. Functional constipation and outlet delay: a population-based study. Gastroenterology 1993 Sep; 105(3): 781–90PubMedGoogle Scholar
  7. 7.
    Donald IP, Smith RG, Cruikshank JG, et al. A study of constipation in the elderly living at home. Gerontology 1985; 31(2): 112–8PubMedCrossRefGoogle Scholar
  8. 8.
    Whitehead WE, Drinkwater D, Cheskin LJ, et al. Constipation in the elderly living at home: definition, prevalence, and relationship to lifestyle and health status. J Am Geriatr Soc 1989 May; 37(5): 423–9PubMedGoogle Scholar
  9. 9.
    Harari D, Gurwitz JH, Avorn J, et al. Bowel habit in relation to age and gender: findings from the National Health Interview Survey and clinical implications. Arch Intern Med 1996 Feb 12; 156(3): 315–20PubMedCrossRefGoogle Scholar
  10. 10.
    Pare P, Ferrazzi S, Thompson WG, et al. An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 2001 Nov; 96(11): 3130–7PubMedCrossRefGoogle Scholar
  11. 11.
    Sonnenberg A, Koch TR. Physician visits in the United States for constipation: 1958 to 1986. Dig Dis Sci 1989 Apr; 34(4): 606–11PubMedCrossRefGoogle Scholar
  12. 12.
    Johanson JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol 1989 Oct; 11(5): 525–36PubMedCrossRefGoogle Scholar
  13. 13.
    Talley NJ, Fleming KC, Evans JM, et al. Constipation in an elderly community: a study of prevalence and potential risk factors. Am J Gastroenterol 1996 Jan; 91(1): 19–25PubMedGoogle Scholar
  14. 14.
    Campbell AJ, Busby WJ, Horwath CC. Factors associated with constipation in a community based sample of people aged 70 years and over. J Epidemiol Community Health 1993 Feb; 47(1): 23–6PubMedCrossRefGoogle Scholar
  15. 15.
    Dukas L, Willett WC, Giovannucci EL. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol 2003 Aug; 98(8): 1790–6PubMedCrossRefGoogle Scholar
  16. 16.
    Rouse M, Chapman N, Mahapatra M, et al. An open, randomised, parallel group study of lactulose versus ispaghula in the treatment of chronic constipation in adults. Br J Clin Pract 1991; 45(1): 28–30PubMedGoogle Scholar
  17. 17.
    Monane M, Avorn J, Beers MH, et al. Anticholinergic drug use and bowel function in nursing home patients. Arch Intern Med 1993 Mar 8; 153(5): 633–8PubMedCrossRefGoogle Scholar
  18. 18.
    Lamy PP, Krug BH. Review of laxative utilization in a skilled nursing facility. J Am Geriatr Soc 1978 Dec; 26(12): 544–9PubMedGoogle Scholar
  19. 19.
    Robson KM, Kiely DK, Lembo T. Development of constipation in nursing home residents. Dis Colon Rectum 2000 Jul; 43(7): 940–3PubMedCrossRefGoogle Scholar
  20. 20.
    Harari D, Gurwitz JH, Avorn J, et al. Correlates of regular laxative use by frail elderly persons. Am J Med 1995 Nov; 99(5): 513–8PubMedCrossRefGoogle Scholar
  21. 21.
    O’Keefe EA, Talley NJ, Zinsmeister AR, et al. Bowel disorders impair functional status and quality of life in the elderly: a population-based study. J Gerontol A Biol Sci Med Sci 1995 Jul; 50(4): M184–9PubMedCrossRefGoogle Scholar
  22. 22.
    Wolfsen CR, Barker JC, Mitteness LS. Constipation in the daily lives of frail elderly people. Arch Fam Med 1993 Aug; 2(8): 853–8PubMedCrossRefGoogle Scholar
  23. 23.
    Irvine EJ, Ferrazzi S, Pare P, et al. Health-related quality of life in functional GI disorders: focus on constipation and resource utilization. Am J Gastroenterol 2002 Aug; 97(8): 1986–93PubMedCrossRefGoogle Scholar
  24. 24.
    Petticrew M, Watt I, Sheldon T. Systematic review of the effectiveness of laxatives in the elderly. Health Technol Assess 1997; I(13): 1–52Google Scholar
  25. 25.
    Tedesco FJ, DiPiro JT. Laxative use in constipation. American College of Gastroenterology’s Committee on FDA-Related Matters. Am J Gastroenterol 1985 Apr; 80(4): 303–9PubMedGoogle Scholar
  26. 26.
    Camilleri M, Lee JS, Viramontes B, et al. Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. J Am Geriatr Soc 2000 Sep; 48(9): 1142–50PubMedGoogle Scholar
  27. 27.
    Orr WC, Chen CL. Aging and neural control of the GI tract: IV. Clinical and physiological aspects of gastrointestinal motility and aging. Am J Physiol 2002 Dec; 283(6): G1226–31Google Scholar
  28. 28.
    McHugh SM, Diamant NE. Effect of age, gender, and parity on anal canal pressures: contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 1987 Jul; 32(7): 726–36PubMedCrossRefGoogle Scholar
  29. 29.
    Akervall S, Nordgren S, Fasth S, et al. The effects of age, gender, and parity on rectoanal functions in adults. Scand J Gastroenterol 1990 Dec; 25(12): 1247–56PubMedCrossRefGoogle Scholar
  30. 30.
    Abyad A, Mourad F. Constipation: common-sense care of the older patient. Geriatrics 1996 Dec; 51(12): 28–34PubMedGoogle Scholar
  31. 31.
    Talley NJ, Jones M, Nuyts G, et al. Risk factors for chronic constipation based on a general practice sample. Am J Gastroenterol 2003 May; 98(5): 1107–11PubMedCrossRefGoogle Scholar
  32. 32.
    Jones RH, Tait CL. Gastrointestinal side-effects of NSAIDs in the community. Br J Clin Pract 1995 Mar; 49(2): 67–70PubMedGoogle Scholar
  33. 33.
    Bjornsson ES, Chey WD, Hooper F, et al. Impaired gastrocolonic response and peristaltic reflex in slow-transit constipation: role of 5-HT(3) pathways. Am J Physiol 2002 Aug; 283(2): G400–7Google Scholar
  34. 34.
    Bassotti G, Imbimbo BP, Betti C, et al. Impaired colonic motor response to eating in patients with slow-transit constipation. Am J Gastroenterol 1992 Apr; 87(4): 504–8PubMedGoogle Scholar
  35. 35.
    Tomita R, Fujisaki S, Ikeda T, et al. Role of nitric oxide in the colon of patients with slow-transit constipation. Dis Colon Rectum 2002 May; 45(5): 593–600PubMedCrossRefGoogle Scholar
  36. 36.
    Tomita R, Tanjoh K, Fujisaki S, et al. Regulation of the enteric nervous system in the colon of patients with slow transit constipation. Hepatogastroenterology 2002 Nov; 49(48): 1540–4PubMedGoogle Scholar
  37. 37.
    Sjolund K, Fasth S, Ekman R, et al. Neuropeptides in idiopathic chronic constipation (slow transit constipation). Neurogastroenterol Motil 1997 Sep; 9(3): 143–50PubMedCrossRefGoogle Scholar
  38. 38.
    Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 1998 Jul; 93(7): 1042–50PubMedCrossRefGoogle Scholar
  39. 39.
    Jones MP, Talley NJ, Nuyts G, et al. Lack of objective evidence of efficacy of laxatives in chronic constipation. Dig Dis Sci 2002 Oct; 47(10): 2222–30PubMedCrossRefGoogle Scholar
  40. 40.
    Tramonte SM, Brand MB, Mulrow CD, et al. The treatment of chronic constipation in adults: a systematic review. J Gen Intern Med 1997 Jan; 12(1): 15–24PubMedCrossRefGoogle Scholar
  41. 41.
    DiPalma JA, DeRidder PH, Orlando RC, et al. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol 2000 Feb; 95(2): 446–50PubMedCrossRefGoogle Scholar
  42. 42.
    Corazziari E, Badiali D, Bazzocchi G, et al. Long term efficacy, safety, and tolerability of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Gut 2000 Apr; 46(4): 522–6PubMedCrossRefGoogle Scholar
  43. 43.
    Attar A, Lemann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999 Feb; 44(2): 226–30PubMedCrossRefGoogle Scholar
  44. 44.
    Chaussade S, Minic M. Comparison of efficacy and safety of two doses of two different polyethylene glycol-based laxatives in the treatment of constipation. Aliment Pharmacol Ther 2003 Jan; 17(1): 165–72PubMedCrossRefGoogle Scholar
  45. 45.
    Eichhorn TE, Oertel WH. Macrogol 3350/electrolyte improves constipation in Parkinson’s disease and multiple system atrophy. Mov Disord 2001 Nov; 16(6): 1176–7PubMedCrossRefGoogle Scholar
  46. 46.
    Lefkowitz MP, Rueegg PC, Shi Y, et al. Validation of a global relief measure in two clinical trials of irritable bowel syndrome with tegaserod [abstract]. Gastroenterology 2000; 118Suppl 2 (Pt 1): A145CrossRefGoogle Scholar
  47. 47.
    Tonini M. Recent advances in the pharmacology of gastrointestinal prokinetics. Pharmacol Res 1996 Apr; 33(4–5): 217–26PubMedCrossRefGoogle Scholar
  48. 48.
    Kellow J, Lee OY, Chang FY, et al. An Asia-Pacific, double blind, placebo controlled, randomised study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome. Gut 2003 May; 52(5): 671–6PubMedCrossRefGoogle Scholar
  49. 49.
    Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther 2001 Oct; 15(10): 1655–66PubMedCrossRefGoogle Scholar
  50. 50.
    Novick J, Miner P, Krause R, et al. A randomized, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2002 Nov; 16(11): 1877–88PubMedCrossRefGoogle Scholar
  51. 51.
    Coremans G, Kerstens R, De Pauw M, et al. Prucalopride is effective in patients with severe chronic constipation in whom laxatives fail to provide adequate relief: results of a double-blind, placebo-controlled clinical trial. Digestion 2003; 67(1–2): 82–9PubMedCrossRefGoogle Scholar
  52. 52.
    Verne GN, Eaker EY, Davis RH, et al. Colchicine is an effective treatment for patients with chronic constipation: an open-label trial. Dig Dis Sci 1997 Sep; 42(9): 1959–63PubMedCrossRefGoogle Scholar
  53. 53.
    Verne GN, Davis RH, Robinson ME, et al. Treatment of chronic constipation with colchicine: randomized, double-blind, placebo-controlled, crossover trial. Am J Gastroenterol 2003 May; 98(5): 1112–6PubMedGoogle Scholar
  54. 54.
    Soffer EE, Metcalf A, Launspach J. Misoprostol is effective treatment for patients with severe chronic constipation. Dig Dis Sci 1994 May; 39(5): 929–33PubMedCrossRefGoogle Scholar
  55. 55.
    Roarty TP, Weber F, Soykan I, et al. Misoprostol in the treatment of chronic refractory constipation: results of a long-term open label trial. Aliment Pharmacol Ther 1997 Dec; 11(6): 1059–66PubMedCrossRefGoogle Scholar
  56. 56.
    Chalazonitis A, Pham TD, Rothman TP, et al. Neurotrophin-3 is required for the survival-differentiation of subsets of developing enteric neurons. J Neurosci 2001 Aug 1; 21(15): 5620–36PubMedGoogle Scholar
  57. 57.
    Parkman HP, Rao SS, Reynolds JC, et al. Neurotrophin-3 improves functional constipation. Am J Gastroenterol 2003 Jun; 98(6): 1338–47PubMedCrossRefGoogle Scholar
  58. 58.
    Towers AL, Burgio KL, Locher JL, et al. Constipation in the elderly: influence of dietary, psychological, and physiological factors. J Am Geriatr Soc 1994 Jul; 42(7): 701–6PubMedGoogle Scholar
  59. 59.
    Lindeman RD, Romero LJ, Liang HC, et al. Do elderly persons need to be encouraged to drink more fluids? J Gerontol A Biol Sci Med Sci 2000 Jul; 55(7): M361–5PubMedCrossRefGoogle Scholar
  60. 60.
    Meshkinpour H, Selod S, Movahedi H, et al. Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci 1998 Nov; 43(11): 2379–83PubMedCrossRefGoogle Scholar
  61. 61.
    Petticrew M, Rodgers M, Booth A. Effectiveness of laxatives in adults. Qual Health Care 2001 Dec; 10(4): 268–73PubMedCrossRefGoogle Scholar
  62. 62.
    Golzarian J, Scott Jr HW, Richards WO. Hypermagnesemiainduced paralytic ileus. Dig Dis Sci 1994 May; 39(5): 1138–42PubMedCrossRefGoogle Scholar
  63. 63.
    Muller-Lissner SA. Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis. BMJ Clin Res 1988 Feb 27; 296(6622): 615–7CrossRefGoogle Scholar
  64. 64.
    Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994 Jul 2; 344(8914): 39–40PubMedCrossRefGoogle Scholar
  65. 65.
    Chokhavatia S, Philipps T, Anuras S. Comparative laxation of calcium polycarbophil with psyllium muciloid in an ambulatory geriatric population. Curr Ther Res Clin Exp 1988; 44: 1013–9Google Scholar
  66. 66.
    Ashraf W, Pfeiffer RF, Park F, et al. Constipation in Parkinson’s disease: objective assessment and response to psyllium. Mov Disord 1997 Nov; 12(6): 946–51PubMedCrossRefGoogle Scholar
  67. 67.
    McRorie JW, Daggy BP, Morel JG, et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998 May; 12(5): 491–7PubMedCrossRefGoogle Scholar
  68. 68.
    Voderholzer WA, Schatke W, Muhldorfer BE, et al. Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol 1997 Jan; 92(1): 95–8PubMedGoogle Scholar
  69. 69.
    Kinnunen O, Salokannel J. Comparison of the effects of magnesium hydroxide and a bulk laxative on lipids, carbohydrates, vitamins A and E, and minerals in geriatric hospital patients in the treatment of constipation. J Int Med Res 1989 Sep; 17(5): 442–54PubMedGoogle Scholar
  70. 70.
    Kinnunen O, Salokannel J. Constipation in elderly long-stay patients: its treatment by magnesium hydroxide and bulk-laxative. Ann Clin Res 1987; 19(5): 321–3PubMedGoogle Scholar
  71. 71.
    Lederle FA, Busch DL, Mattox KM, et al. Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose. Am J Med 1990 Nov; 89(5): 597–601PubMedCrossRefGoogle Scholar
  72. 72.
    Passmore AP, Wilson-Davies K, Stoker C, et al. Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. BMJ 1993 Sep 25; 307(6907): 769–71PubMedCrossRefGoogle Scholar
  73. 73.
    Christie AH, Culbert P, Guest JF. Economic impact of low dose polyethylene glycol 3350 plus electrolytes compared with lactulose in the management of idiopathic constipation in the UK. Pharmacoeconomics 2002; 20(1): 49–60PubMedCrossRefGoogle Scholar
  74. 74.
    Culbert P, Gillett H, Ferguson A. Highly effective oral therapy (polyethylene glycol/electrolyte solution) for faecal impaction and severe constipation. Clin Drugs Invest 1998; 16(5): 355–60CrossRefGoogle Scholar
  75. 75.
    Argent A, Hatherill M, Reynolds L, et al. Fulminant pulmonary oedema after administration of a balanced electrolyte polyethylene glycol solution. Arch Dis Child 2002 Mar; 86(3): 209PubMedCrossRefGoogle Scholar
  76. 76.
    Paap CM, Ehrlich R. Acute pulmonary edema after polyethylene glycol intestinal lavage in a child. Ann Pharmacother 1993 Sep; 27(9): 1044–7PubMedGoogle Scholar
  77. 77.
    Marschall HU, Bartels F. Life-threatening complications of nasogastric administration of polyethylene glycol-electrolyte solutions (Golytely) for bowel cleansing. Gastrointest Endosc 1998 May; 47(5): 408–10PubMedCrossRefGoogle Scholar
  78. 78.
    Lembo A, Camilleri M. Chronic constipation. N Engl J Med 2003 Oct 2; 349(14): 1360–8PubMedCrossRefGoogle Scholar
  79. 79.
    Joo JS, Ehrenpreis ED, Gonzalez L, et al. Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited. J Clin Gastroenterol 1998 Jun; 26(4): 283–6PubMedCrossRefGoogle Scholar
  80. 80.
    Wald A. Is chronic use of stimulant laxatives harmful to the colon? J Clin Gastroenterol 2003 May; 36(5): 386–9PubMedCrossRefGoogle Scholar
  81. 81.
    Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001 Aug; 44(8): 1201–9PubMedCrossRefGoogle Scholar
  82. 82.
    Kinnunen O, Winblad I, Koistinen P, et al. Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Pharmacology 1993 Oct; 47: Suppl. 1: 253–5PubMedCrossRefGoogle Scholar
  83. 83.
    Badiali D, Marcheggiano A, Pallone F, et al. Melanosis of the rectum in patients with chronic constipation. Dis Colon Rectum 1985 Apr; 28(4): 241–5PubMedCrossRefGoogle Scholar
  84. 84.
    Nascimbeni R, Donato F, Ghirardi M, et al. Constipation, anthranoid laxatives, melanosis coli, and colon cancer: a risk assessment using aberrant crypt foci. Cancer Epidemiol Biomarkers Prev 2002 Aug; 11(8): 753–7PubMedGoogle Scholar
  85. 85.
    Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000 May; 46(5): 651–5PubMedCrossRefGoogle Scholar
  86. 86.
    NHS Center for Reviews and Dissemination. Effectiveness of laxatives in adults. Eff Health Care 2001 Sep; 7(1): 1–12Google Scholar
  87. 87.
    Williamson J, Coll M, Connolly M. A comparative trial of a new laxative. Nurs Times 1975 Oct 23; 71(43): 1705–7PubMedGoogle Scholar
  88. 88.
    MacLennan WJ, Pooler AFWM. A comparison of sodium picosulphate (‘Laxoberal’) with standardised senna (‘Senokot’) in geriatric patients. Curr Med Res Opin 1974; 2(10): 641–7PubMedCrossRefGoogle Scholar
  89. 89.
    Bouras EP, Camilleri M, Burton DD, et al. Selective stimulation of colonic transit by the benzofuran 5HT4 agonist, prucalopride, in healthy humans. Gut 1999 May; 44(5): 682–6PubMedCrossRefGoogle Scholar
  90. 90.
    Joslyn A, Stevens M, De Pauw M, et al. Prucalopride is safe and generally well tolerated in elderly patients with chronic constipation [abstract]. Am J Gastroenterol 2000; 95: 2537–8CrossRefGoogle Scholar
  91. 91.
    Camilleri M. Review article: tegaserod. Aliment Pharmacol Ther 2001 Mar; 15(3): 277–89PubMedCrossRefGoogle Scholar
  92. 92.
    Chey WD. Tegaserod and other serotonergic agents: what is the evidence? Rev Gastroenterol Disord 2003; 3Suppl. 2: S35–40PubMedGoogle Scholar
  93. 93.
    Appel-Dingemanse S. Clinical pharmacokinetics of tegaserod, a serotonin 5-HT(4) receptor partial agonist with promotile activity. Clin Pharmacokinetics 2002; 41(13): 1021–42CrossRefGoogle Scholar
  94. 94.
    Hasler WL, Heldsinger A, Chung OY. Erythromycin contracts rabbit colon myocytes via occupation of motilin receptors. Am J Physiol 1992 Jan; 262 (1 Pt 1): G50–5PubMedGoogle Scholar
  95. 95.
    Bellomo-Brandao MA. Use of erythromycin for the treatment of severe chronic constipation in children [abstract]. Braz J Med Biol Res 2003; 36: 1391–6PubMedCrossRefGoogle Scholar
  96. 96.
    Sun WM, Hasler WL, Lien HC, et al. Nizatidine enhances the gastrocolonic response and the colonic peristaltic reflex in humans. J Pharmacol Exp Ther 2001 Oct; 299(1): 159–63PubMedGoogle Scholar
  97. 97.
    Coulie B, Szarka LA, Camilleri M, et al. Recombinant human neurotrophic factors accelerate colonic transit and relieve constipation in humans. Gastroenterology 2000 Jul; 119(1): 41–50PubMedCrossRefGoogle Scholar
  98. 98.
    Zhao H, Liu JP, Liu ZS, et al. Acupuncture for chronic constipation. Cochrane Database Syst Rev 2003; (3): CD004117Google Scholar
  99. 99.
    Read NW, Timms JM, Barfield LJ, et al. Impairment of defecation in young women with severe constipation. Gastroenterology 1986 Jan; 90(1): 53–60PubMedGoogle Scholar
  100. 100.
    Chiotakakou-Faliakou E, Kamm MA, Roy AJ, et al. Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut 1998 Apr; 42(4): 517–21PubMedCrossRefGoogle Scholar
  101. 101.
    Verne GN, Hocking MP, Davis RH, et al. Long-term response to subtotal colectomy in colonic inertia. J Gastrointest Surg 2002 Sep; 6(5): 738–44PubMedCrossRefGoogle Scholar
  102. 102.
    Aldulaymi BH, Rasmussen OA, Christiansen J. Long-term results of subtotal colectomy for severe slow-transit constipation in patients with normal rectal function. Colorectal Dis 2001; 3(6): 392–5PubMedCrossRefGoogle Scholar
  103. 103.
    Nylund G, Oresland T, Fasth S, et al. Long-term outcome after colectomy in severe idiopathic constipation. Colorectal Dis 2001; 3(4): 253–8PubMedCrossRefGoogle Scholar
  104. 104.
    Albanese A, Brisinda G, Bentivoglio AR, et al. Treatment of outlet obstruction constipation in Parkinson’s disease with botulinum neurotoxin A. Am J Gastroenterol 2003 Jun; 98(6): 1439–40PubMedCrossRefGoogle Scholar
  105. 105.
    Coggrave M, Wiesel PH, Norton C, et al. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database of Systematic Reviews 2003; (3): CD002115Google Scholar
  106. 106.
    Goodman ML, Wilkinson S. Laxatives for the management of constipation in palliative care patients. Cochrane Database of Systematic Reviews 2003; (3): CD003448Google Scholar
  107. 107.
    Klaschik E, Nauck F, Ostgathe C. Constipation: modern laxative therapy. Support Care Cancer 2003 Nov; 11(11): 679–85PubMedCrossRefGoogle Scholar
  108. 108.
    Smith S. Evidence-based management of constipation in the oncology patient. Eur J Oncol Nurs 2001 Mar; 5(1): 18–25PubMedCrossRefGoogle Scholar
  109. 109.
    Harari D, Gurwitz JH, Minaker KL. Constipation in the elderly. J Am Geriatr Soc 1993 Oct; 41(10): 1130–40PubMedGoogle Scholar
  110. 110.
    Romero Y, Evans JM, Fleming KC, et al. Constipation and fecal incontinence in the elderly population. Mayo Clin Proc 1996 Jan; 71: 81–92PubMedCrossRefGoogle Scholar
  111. 111.
    Documed. Compendium Suisse des medicants. [online]. Available from URL: http://www.documed.ch. [Accessed 2004 May 21]
  112. 112.
    Pekmezaris R, Aversa L, Wolf-Klein G, et al. The cost of chronic constipation. J Am Med Dir Assoc 2002; 3: 224–8PubMedCrossRefGoogle Scholar
  113. 113.
    Lori F, Schmier J, Kleinman L, et al. Time and economic cost of constipation care in the nursing home. J Am Med Dir Assoc 2002; 3: 215–23CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Wanda Bosshard
    • 1
  • Rebecca Dreher
    • 1
  • Jean-François Schnegg
    • 2
  • Christophe J. Büla
    • 1
  1. 1.Division of Geriatric Medicine and Geriatric Rehabilitation, Department of Internal MedicineCentre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland
  2. 2.Service of Gastroenterology, Department of Internal MedicineCentre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland

Personalised recommendations