Drugs & Aging

, Volume 25, Issue 10, pp 807–821 | Cite as

Management of Chronic Constipation in the Elderly

  • Paul F. Gallagher
  • Denis O’Mahony
  • Eamonn M. M. QuigleyEmail author
Review Article


Constipation is a significant healthcare problem in the elderly. However, while undoubtedly common in the elderly, data on the prevalence of constipation in general and of its subtypes vary considerably, depending on the nature of the study population and their location. Furthermore, the complexity of the pathophysiology of constipation in this age group is little appreciated. Assumptions regarding ‘agerelated changes in colorectal physiology’ are, for the most part, not supported by scientific evidence and may serve to distract the clinician from uncovering the contributions of co-morbid diseases and the impact of iatrogenic factors. The evidence base from which one can develop recommendations on the management of constipation in the elderly is, for the most part, slim. This becomes most starkly apparent when one attempts to critically assess specific approaches to management. There is insufficient evidence to support the use of many commonly used laxatives both in the general population and in the elderly. Lifestyle interventions have value for some patients but data are lacking on the benefits of these interventions for patients with chronic constipation. Data in the elderly do not exist for most new pharmacological approaches to constipation. Pending the availability of good data, management of constipation in the elderly should be tailored to each individual’s needs and expectations, regardless of age or place of residence. In certain situations, constipation may be complicated by the development of impaction; preventive strategies are important in this context. We urge enrolment of many more elderly individuals with chronic constipation in clinical trials designed to address their particular needs.


Constipation Irritable Bowel Syndrome Familial Mediterranean Fever Misoprostol Lactulose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    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; 94: 3530–40PubMedCrossRefGoogle Scholar
  2. 2.
    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; 96: 3130–7PubMedCrossRefGoogle Scholar
  3. 3.
    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; 50: M184–9PubMedCrossRefGoogle Scholar
  4. 4.
    Wolfsen CR, Barker JC, Mitteness LS. Constipation in the daily lives of frail elderly people. Arch Fam Med 1993; 2: 853–8PubMedCrossRefGoogle Scholar
  5. 5.
    Johanson JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol 1989; 11: 525–36PubMedCrossRefGoogle Scholar
  6. 6.
    Harari D, Gurwitz JH, Minaker KL. Constipation in the elderly. J Am Geriatr Soc 1993; 41: 1130–40PubMedGoogle Scholar
  7. 7.
    Prescription cost analysis. England 2006 [online]. Available from URL: [Accessed 2007 Jul 9]
  8. 8.
    Drossman DA, Sandier RS, McKee DC, et al. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 1982; 83: 529–34PubMedGoogle Scholar
  9. 9.
    Connell AM, Hilton C, Irvine G. Variation of bowel habit in two population samples. BMJ 1965; 2: 1095–9PubMedCrossRefGoogle Scholar
  10. 10.
    Thompson WG, Heaton KW. Functional bowel disorders in apparently healthy people. Gastroenterology 1980; 79: 283–8PubMedGoogle Scholar
  11. 11.
    Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care. Dig Dis Sci 1987; 32: 841–5PubMedCrossRefGoogle Scholar
  12. 12.
    Locke III GR, Pemberton JH, Phillips SE. AGA technical review on constipation. Gastroenterology 2000; 119: 1766–78PubMedCrossRefGoogle Scholar
  13. 13.
    Harari D, Gurwitz JH, Avorn J, et al. Constipation: assessment and management in an institutionalised elderly population. J Am Geriatr Soc 1994; 42: 947–52PubMedGoogle Scholar
  14. 14.
    Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut 1999; 45: II43–7PubMedCrossRefGoogle Scholar
  15. 15.
    Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology 2006; 130: 1480–91PubMedCrossRefGoogle Scholar
  16. 16.
    Talley NJ. Definitions, epidemiology, and impact of chronic constipation. Rev Gastroenterol Disord 2004; 4Suppl. 2: S3–10PubMedGoogle Scholar
  17. 17.
    American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol 2005; 100Suppl. 1: S1–4CrossRefGoogle Scholar
  18. 18.
    Brandt LJ, Prather CM, Quigley EMM, et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005 Jul; 100Suppl. 1: S5–22PubMedCrossRefGoogle Scholar
  19. 19.
    Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 2004; 99: 750–9PubMedCrossRefGoogle Scholar
  20. 20.
    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; 156: 315–20PubMedCrossRefGoogle Scholar
  21. 21.
    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; 91: 19–25PubMedGoogle Scholar
  22. 22.
    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; 47: 23–6PubMedCrossRefGoogle Scholar
  23. 23.
    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; 98: 1790–6PubMedCrossRefGoogle Scholar
  24. 24.
    Heaton KW. Cleave and the fibre story. J R Nav Med Serv 1980; 31: 112–8Google Scholar
  25. 25.
    Donald IP, Smith RG, Cruikshank JG, et al. A study of constipation in the elderly living at home. Gerontology 1985; 31: 112–8PubMedCrossRefGoogle Scholar
  26. 26.
    Monane M, Avorn J, Beers MH, et al. Anticholinergic drug use and bowel function in nursing home patients. Arch Intern Med 1993; 153: 633–8PubMedCrossRefGoogle Scholar
  27. 27.
    Primrose WR, Capewell AE, Simpson GK, et al. Prescribing patterns observed in registered nursing homes and long-stay geriatric wards. Age Ageing 1987; 16: 25–8PubMedCrossRefGoogle Scholar
  28. 28.
    Robson KM, Kiely DK, Lembo T. Development of constipation in nursing home residents. Dis Colon Rectum 2000; 43: 940–3PubMedCrossRefGoogle Scholar
  29. 29.
    McHugh SM, Diamant NE. Effect of age, gender and parity on anal canal pressures. Contribution of impaired anal sphincter function to faecal incontinence. Dig Dis Sci 1987; 21: 726–36CrossRefGoogle Scholar
  30. 30.
    Lundberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 1989; 32: 737–42CrossRefGoogle Scholar
  31. 31.
    Haadem K, Dahlstrom JA, Ling L. Anal sphincter competence in healthy women: clinical implications of age and other factors. Obstet Gynecol 1991; 78: 823–7PubMedGoogle Scholar
  32. 32.
    Ryhammer AM, Laurberg S, Sorensen FH. Effects of age on anal function in normal women. Int J Colorectal Dis 1997; 12: 225–9PubMedCrossRefGoogle Scholar
  33. 33.
    Bannister JJ, Abouzekry L, Read NW. Effect of ageing on anorectal function. Gut 1987; 28: 353–7PubMedCrossRefGoogle Scholar
  34. 34.
    Madsen JL. Effects of gender, age and body mass index on gastrointestinal transit times. Dig Dis Sci 1992; 37: 235–8CrossRefGoogle Scholar
  35. 35.
    Brogna A, Ferrara R, Bucceri AM, et al. Influence of aging on gastrointestinal transit time. An ultrasonographic and radiologic study. Invest Radiol 1999; 34: 357–9PubMedCrossRefGoogle Scholar
  36. 36.
    Meir R, Beglinger C, Dederding JP, et al. Age- and sex-specific standard values of colonic transit time in healthy subjects. Schweiz Med Wochenschr 1992; 122: 940–3PubMedGoogle Scholar
  37. 37.
    Loening-Baucke V, Anuras S. Sigmoidal and rectal motility in healthy elderly. J Am Geriatr Soc 1984; 32: 887–91PubMedGoogle Scholar
  38. 38.
    Lembo A, Camilleri M. Chronic constipation. N Engl J Med 2003; 349: 1360–8PubMedCrossRefGoogle Scholar
  39. 39.
    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; 45: 593–600PubMedCrossRefGoogle Scholar
  40. 40.
    Bassotti G, Imbimbo BP, Betti C, et al. Impaired colonic motor response to eating in patients with slow-transit constipation. Am J Gastroenterol 1992; 87: 504–8PubMedGoogle Scholar
  41. 41.
    Tomita R, Tanjoh K, Fujisaki S, et al. Regulation of the enteric nervous system in the colon of patients with slow transit constipation. Hepatogastroenterol 2002; 49: 1540–4Google Scholar
  42. 42.
    Sjolund K, Fasth S, Ekman R, et al. Neuropeptides in idiopathic chronic constipation (slow transit constipation). Neurogastroenterol Motil 1997; 9: 143–50PubMedCrossRefGoogle Scholar
  43. 43.
    Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 1998; 93: 1042–50PubMedCrossRefGoogle Scholar
  44. 44.
    Mertz H, Nalliboff B, Mayer E. Physiology of refractory chronic constipation. Am J Gastroenterol 1999; 94: 609–15PubMedCrossRefGoogle Scholar
  45. 45.
    Towers AL, Burgio KL, Locher JL, et al. Constipation in the elderly: influence of dietary, psychological, and physiological factors. J Am Geriatr Soc 1994; 42: 701–6PubMedGoogle Scholar
  46. 46.
    Muller-Lissner SA, Kamm MA, Scarpignato C, et al. Myths and misconceptions about chronic constipation. Am J Gastroenterol 2005; 100: 232–42PubMedCrossRefGoogle Scholar
  47. 47.
    Gattuso JM, Kamm MA. Clinical features of idiopathic megarectum and idiopathic megacolon. Gut 1997; 41: 92–9Google Scholar
  48. 48.
    Meshkinpour H, Selod S, Movahedi H, et al. Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci 1998; 43: 2379–83PubMedCrossRefGoogle Scholar
  49. 49.
    Brown WJ, Mishra G, Lee C, et al. Leisure time physical activity in Australian women: relationship with well being and symptoms. Res Q Exerc Sport 2000; 71: 206–61PubMedGoogle Scholar
  50. 50.
    Tedesco FJ, DiPiro JT. Laxative use in constipation: American College of Gastroenterology’s Committee on FDA-Related Matters. Am J Gastroenterol 1985; 80: 1142–50Google Scholar
  51. 51.
    Jones MP, Talley NJ, Nuyts G, et al. Lack of objective evidence of efficacy of laxatives in chronic constipation. Dig Dis Sci 2002; 47: 2222–30PubMedCrossRefGoogle Scholar
  52. 52.
    Tramonte SM, Brand MB, Mulrow CD, et al. The treatment of chronic constipation in adults: a systematic review. J Gen Intern Med 1997; 12: 15–24PubMedCrossRefGoogle Scholar
  53. 53.
    Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol 2005; 100: 936–71PubMedCrossRefGoogle Scholar
  54. 54.
    Harari D, Gurwitz JH, Avorn J, et al. Correlates of regular laxative use by frail elderly persons. Am J Med 1995; 99(5): 513–8PubMedCrossRefGoogle Scholar
  55. 55.
    Fenn GC, Wilkinson PD, Lee CE, et al. A general practice study of the efficacy of Regulan in functional constipation. Br J Clin Pract 1986; 40: 192–7PubMedGoogle Scholar
  56. 56.
    Ashraf W, Park F, Lof J, et al. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther 1995; 9: 639–47PubMedCrossRefGoogle Scholar
  57. 57.
    Cheskin LJ, Kamal N, Crowell MD, et al. Mechanisms of constipation in older persons and effects of fibre compared with placebo. J Am Geriatr Soc 1995; 43: 666–9PubMedGoogle Scholar
  58. 58.
    Ashraf W, Pfeiffer RF, Park F, et al. Constipation in Parkinsons’s disease: objective assessment and response to psyllium. Mov Disord 1997; 12: 946–51PubMedCrossRefGoogle Scholar
  59. 59.
    Mamtani R, Cimina JA, Kugel R, et al. A calcium salt of an insoluble synthetic bulking laxative in elderly bed ridden nursing home residents. J Am Coll Nutr 1989; 8: 554–6PubMedGoogle Scholar
  60. 60.
    Dettmar PW, Skyes J. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin 1998; 14: 227–33PubMedCrossRefGoogle Scholar
  61. 61.
    McRorie JW, Daggy BP, Morel JG, et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998; 12: 491–917PubMedCrossRefGoogle Scholar
  62. 62.
    Mantle J. Research and serendipitous secondary findings. Can Nurs 1992; 88: 15–8Google Scholar
  63. 63.
    Finlay M. The use of dietary fibre in a long-stay geriatric ward. J Nutri Elder 1988; 8: 19–30CrossRefGoogle Scholar
  64. 64.
    Voderholzer WA, Schatte W, Muhldorfer BE, et al. Clinical response to dietary fibre treatment of chronic constipation. Am J Gastroenterol 1997; 92: 95–8PubMedGoogle Scholar
  65. 65.
    Hamilton JW, Wagner J, Burdick BB, et al. Clinical evaluation of methylcellulose as a bulk laxative. Dig Dis Sci 1988; 33: 913–8CrossRefGoogle Scholar
  66. 66.
    McQuaid KR. Symptoms and signs of gastrointestinal disease. In: Tierney LM, McPhee SJ, Papadakis MA, editors. Current medical diagnosis and treatment. 44th ed. New York: The McGraw-Hill Companies, 2005: 525Google Scholar
  67. 67.
    Xing JH, Soffer E. Adverse effects of laxatives. Dis Colon Rectum 2001; 44: 1201–9PubMedCrossRefGoogle Scholar
  68. 68.
    Kinnunen O, Salokannel J. Constipation in elderly long-stay patients: its treatment by magnesium hydroxide and bulk-laxative. Ann Clin Res 1987; 19: 321–3PubMedGoogle Scholar
  69. 69.
    Golzarian J, Scott Jr HW, Richards WO. Hypermagnesaemia induced paralytic ileus. Dig Dis Sci 1994; 39: 1138–42PubMedCrossRefGoogle Scholar
  70. 70.
    Lederle FA, Busch DL, Mattox KM, et al. Cost-effective treatment of constipation in the elderly: a randomised double-blind comparison of sorbitol and lactulose. Am J Med 1990; 89: 597–601PubMedCrossRefGoogle Scholar
  71. 71.
    Bass P, Dennis S. The laxative effects of lactulose in normal and constipated subjects. J Clin Gastroenterol 1981; 3: 23–8PubMedCrossRefGoogle Scholar
  72. 72.
    Wesselius-De Casparis A, Braadbaart S, Bergh-Bohlken GE, et al. Treatment of chronic constipation with lactulose syrup: results of a double-blind study. Gut 1968; 9: 84–6PubMedCrossRefGoogle Scholar
  73. 73.
    Sanders JF. Lactulose syrup assessed in a double blind study of elderly constipated patients. J Am Geriatr Soc 1978; 26: 236–9PubMedGoogle Scholar
  74. 74.
    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; 44: 226–30PubMedCrossRefGoogle Scholar
  75. 75.
    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
  76. 76.
    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; 46: 522–6PubMedCrossRefGoogle Scholar
  77. 77.
    Andorsky RI, Goldner F. Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double blind, placebo-controlled study. Am J Gastroenterol 1990; 85: 261–5PubMedGoogle Scholar
  78. 78.
    Cleveland MV, Flavin DP, Ruben RA, et al. New polyethylene glycol laxative for treatment of constipation in adults: a randomised, double-blind, placebo-controlled study. South Med Assoc J 2001; 94: 478–81Google Scholar
  79. 79.
    Corazziarri E, Badiali D, Habib FI, et al. Small volume isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci 1996; 41: 1636–42CrossRefGoogle Scholar
  80. 80.
    DiPalma JA, DeRidder PH, Orlando RC, et al. A randomised, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol 2000; 95: 446–50PubMedCrossRefGoogle Scholar
  81. 81.
    Freedman MD, Schwartz HJ, Roby R, et al. Tolerance and efficacy of polyethylene glycol 3350/electrolyte solution versus lactulose in relieving opiate induced constipation: a double-blind placebo-controlled trial. J Clin Pharmacol 1997; 37: 904–7PubMedGoogle Scholar
  82. 82.
    Chaussade S, Minie M. Comparison of efficacy and safety of two different polyethylene glycol-based laxatives in the treatment of constipation. Aliment Pharmacol Ther 2003; 17: 165–72PubMedCrossRefGoogle Scholar
  83. 83.
    Wong A, Briars GL. Acute pulmonary oedema complicating polyethylene glycol intestinal lavage. Arch Dis Child 2002 Dec; 87(6): 537PubMedCrossRefGoogle Scholar
  84. 84.
    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
  85. 85.
    Petticrew M, Watt I, Sheldon T. Systematic review of the effectiveness of laxatives in the elderly. Health Technol Assess 1997; 1: 1–52Google Scholar
  86. 86.
    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; 26: 283–6PubMedCrossRefGoogle Scholar
  87. 87.
    Wald A. Is chronic use of stimulant laxatives harmful to the colon? J Clin Gastroenterol 2003; 36: 386–9PubMedCrossRefGoogle Scholar
  88. 88.
    Nascimbeni R, Donate 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; 11: 241–5Google Scholar
  89. 89.
    Castle SC, Cantrell M, Israel DS, et al. Constipation prevention: empiric use of stool softeners questioned. Geriatrics 1991; 46: 84–6PubMedGoogle Scholar
  90. 90.
    Camilleri M. Review article: tegaserod. Aliment Pharmacol Ther 2001; 15: 277–89PubMedCrossRefGoogle Scholar
  91. 91.
    Prather CM, Camilleri M, Zinsmeister AR, et al. Tegaserod accelerates oro-cecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterol 2000; 118: 463–8CrossRefGoogle Scholar
  92. 92.
    Gegen L, Matzinger D, Merz M, et al. Tegaserod, a 5 HT 4 receptor partial agonist, accelerates gastric emptying and gastrointestinal transit in healthy male subjects. Aliment Pharmacol Ther 2001; 15: 1745–51CrossRefGoogle Scholar
  93. 93.
    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; 52: 671–6PubMedCrossRefGoogle Scholar
  94. 94.
    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; 15: 1655–66PubMedCrossRefGoogle Scholar
  95. 95.
    Novick J, Miner P, Krause R, et al. A randomised, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2002; 16: 1877–88PubMedCrossRefGoogle Scholar
  96. 96.
    Quigley EM, Wald A, Fidelholtz J, et al. Safety and tolerability of tegaserod in patients with chronic constipation: pooled data from two phase III studies. Clin Gastroenterol Hepatol 2006; 4: 605–13PubMedCrossRefGoogle Scholar
  97. 97.
    Bouras EP, Camilleri M, Bruton DD, et al. Selective stimulation of colonic transit by the benzofuran 5HT4 agonist, prucalopride, in healthy humans. Gut 1999; 44: 682–6PubMedCrossRefGoogle Scholar
  98. 98.
    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: 82–9PubMedCrossRefGoogle Scholar
  99. 99.
    Appel-Dingemanse S. Clinical pharmacokinetics of tegaserod, a serotonin 5-HT(4) receptor partial agonist with promotile activity. Clin Pharmacokinetics 2002; 41: 1021–42CrossRefGoogle Scholar
  100. 100.
    Camilleri M, Kerstens R, Rykx A, et al. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med 2008; 358: 2344–54PubMedCrossRefGoogle Scholar
  101. 101.
    Sharma SS, Bhargava N, Mathur SC. Effect of oral erythromycin on colonic transit in patients with idiopathic constipation: a pilot study. Dig Dis Sci 1995; 40: 2446–9PubMedCrossRefGoogle Scholar
  102. 102.
    Meier R, Beglinger C, Thumshirn M, et al. Therapeutic effects of loxiglumide, a cholecystokinin antagonist, on chronic constipation in elderly patients: a prospective, randomised, double-blind controlled trial. J Gastrointest Mot 1993; 5: 129–35CrossRefGoogle Scholar
  103. 103.
    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; 299: 159–63PubMedGoogle Scholar
  104. 104.
    Verne GN, Davis RH, Robinson ME, et al. Treatment of chronic constipation with colchicine: randomised double-blind, placebo-controlled, crossover trial. Am J Gastroenterol 2003; 98: 1112–6PubMedGoogle Scholar
  105. 105.
    Sandyk R, Gillman MA. Colchicine ameliorates constipation in Parkinson’s disease [letter]. J R Soc Med 1984; 77: 1066PubMedGoogle Scholar
  106. 106.
    Rajapakse R, Warman J, Korelitz BI. Colchicine for persistent constipation after total abdominal colectomy with ileorectostomy for colonic inertia. J Clin Gastroenterol 2001; 33: 81–4PubMedCrossRefGoogle Scholar
  107. 107.
    Soffer E, Metcalf A, Launspach J. Misoprostol is effective treatment for patients with severe chronic constipation. Dig Dis Sci 1994; 39: 929–33PubMedCrossRefGoogle Scholar
  108. 108.
    Johanson JF, Ueno R. Lubiprostone, a locally acting chloride channel activator, in adult patients with chronic constipation: a double-blind, placebo-controlled, dose-ranging study to evaluate efficacy and safety. Aliment Pharmacol Ther 2007; 25: 1351–61PubMedCrossRefGoogle Scholar
  109. 109.
    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; 42: 517–21PubMedCrossRefGoogle Scholar
  110. 110.
    Chiaroni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006; 130: 657–64CrossRefGoogle Scholar
  111. 111.
    Rao SS, Seaton K, Miller M, et al. Randomised controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol 2007; 5: 331–4PubMedCrossRefGoogle Scholar
  112. 112.
    Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev 2007; (3): CD004464Google Scholar
  113. 113.
    Chassagne P, Jego A, Gloc P, et al. Does treatment of constipation improve faecal incontinence in institutionalized elderly patients? Age Aging 2000; 29: 159–64CrossRefGoogle Scholar
  114. 114.
    Harari D, Norton C, Lockwood L, et al. Treatment of constipation and fecal incontinence in stroke patients: randomized controlled trial. Stroke 2004; 35: 2549–55PubMedCrossRefGoogle Scholar
  115. 115.
    Lees NP, Hodson P, Hill J, et al. Long-term results of the antegrade continent enema procedure for constipation in adults. Colorectal Dis 2004; 6: 362–8PubMedCrossRefGoogle Scholar
  116. 116.
    Mendoza J, Lejido J, Rubio S, et al. Systematic review: the adverse effects of sodium phosphate enemas. Aliment Pharmacol Ther 2007; 26: 9–20PubMedCrossRefGoogle Scholar
  117. 117.
    Potter J, Norton C, Cottenden A. editors. Bowel care in older people: research and practice. London: Royal College of Physicians, 2002Google Scholar
  118. 118.
    Ashraf W, Park F, Lof J, et al. An examination of the reliability of reported stool frequency in the diagnosis of idiopathic constipation. Am J Gastroenterol 1996; 91(1): 26–32PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Paul F. Gallagher
    • 1
  • Denis O’Mahony
    • 2
  • Eamonn M. M. Quigley
    • 2
    Email author
  1. 1.Department of Geriatric MedicineCork University HospitalCorkIreland
  2. 2.Alimentary Pharmabiotic Centre, Department of MedicineUniversity College CorkCorkIreland

Personalised recommendations