Skip to main content
SpringerLink
Log in

Constipation in Elderly Patients

Pathogenesis and Management

  • Review Article
  • Drug Therapy
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Summary

The incidence of constipation appears to increase with increasing age, particularly after the age of 65. There are few data on the age-related physiological changes of colonic and anorectal function; however, anal sphincter pressures are decreased in elderly patients, while colonic transit time does not appear to be altered. The successful management of constipation in elderly patients requires an understanding of colorectal function, careful characterisation of the patient’s complaint, and in selected patients, specialised studies of colonic and anorectal function.

The cause of constipation in elderly patients is often multifactorial and may include inactivity, inappropriate diet, depression and confusion, certain medications, and neuromuscular disorders.

The treatment of chronic constipation should be based on the nature of the complaint and the presumed pathophysiological mechanisms at work in each patient. Treatment will be based on one or more strategies including dietary changes, laxatives, and in carefully defined cases, surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Andorsky RI, Goldner F. Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. American Journal of Gastroenterology 85: 261–265, 1990

    PubMed  CAS  Google Scholar 

  • Bannister JJ, Abouzekry L, Read N. Effect of aging on anorectal function. Gut 28: 353–357, 1987

    Article  PubMed  CAS  Google Scholar 

  • Brandt LJ. Constipation in the elderly. Practical Gastroenterology 11: 31–36, 1987

    Google Scholar 

  • Brocklehurst JC, Khan Y. A study of fecal stasis in old age and use of Dorbanex in its prevention. Gerontologia Clinica 2: 293–300, 1969

    Article  Google Scholar 

  • Brocklehurst JC. Colonic disease in the elderly. Clinics in Gastroenterology 14: 725–747, 1985

    PubMed  CAS  Google Scholar 

  • Burkitt DP, Walker ARP, Painter NS. Effect of dietary fibre on stool and transit times and its role in the causation of disease. Lancet 2: 1408–1411, 1972

    Article  PubMed  CAS  Google Scholar 

  • Chapman RU, Sillery J, Fontana DD, Matthys C, Saunders DR. Effect of oral dioctyl sodium sulfosuccinate on intake-output studies of human small and large intestine. Gastroenterology 89: 489–493, 1985

    PubMed  CAS  Google Scholar 

  • Clark ANG, Scott JS. Wheat bran in dyschezia in the aged. Age and Ageing 5: 149–154, 1976

    Article  PubMed  CAS  Google Scholar 

  • Connell AM, Hilton C, Irvin G, Lennard-Jones JE, Misiewicz JJ. Variations in bowel habit in two population samples. British Medical Journal 2: 1095–1099, 1965

    Article  PubMed  CAS  Google Scholar 

  • Cummings JH. Constipation, dietary fibre and the control of large bowel function. Postgraduate Medical Journal 60: 811–819, 1984

    Article  PubMed  CAS  Google Scholar 

  • Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology 78: 991–995, 1980

    PubMed  CAS  Google Scholar 

  • Derogatis LR, Rickeis K, Rock K, Rock AF. The SCL-90 and the M M PI: a step in the validation of a new self-report scale. British Journal of Psychiatry 128: 280–289, 1976

    Article  PubMed  CAS  Google Scholar 

  • Donald IP, Smith RG, Cruikshank JG, Elton RA, Stoddary ME. A study of constipation in the elderly living at home. Gerontology 31: 112–118, 1985

    Article  PubMed  CAS  Google Scholar 

  • Eastwood HGH. Bowel transit studies in the elderly: radioopaque markers in the investigation of constipation. Gerontologia Clinica 14: 154–159, 1972

    Article  PubMed  CAS  Google Scholar 

  • Hope AK, Down EC. Dietary fiber and fluid in the control of constipation in a nursing home population. Medical Journal of Australia 144: 306–307, 1986

    PubMed  CAS  Google Scholar 

  • Hull C, Greco RS, Brooks DC. Alleviation of constipation in the elderly by dietary fiber supplementation. Journal of the American Geriatrics Society 28: 410–414, 1980

    PubMed  CAS  Google Scholar 

  • Hyams DE. Gastrointestinal problems in the old-I. British Medical Journal 1: 107–110, 1974

    Article  PubMed  CAS  Google Scholar 

  • Ihre T, Seligson V. Intussusception of the rectum-internal procidentia: treatment and results in 90 patients. Diseases of the Colon and Rectum 18: 391–396, 1975

    Article  PubMed  CAS  Google Scholar 

  • Johanson JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. Journal of Clinical Gastroenterology 11: 525–536, 1989

    Article  PubMed  CAS  Google Scholar 

  • Loening-Baucke VA. Sensitivity of the sigmoid colon and rectum in children treated for chronic constipation. Journal of Pediatric Gastroenterology and Nutrition 3: 454–459, 1984

    Article  PubMed  CAS  Google Scholar 

  • Lederle FA, Busch DL, Mattox KM, West MJ, Aske DM. Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose. American Journal of Medicine 89: 597–601, 1990

    Article  PubMed  CAS  Google Scholar 

  • Mahieu P, Pringot J, Bodart P. Defecography: II. Contribution to the diagnosis of defecation disorders. Gastrointestinal Radiology 9: 253–261, 1984

    Article  PubMed  CAS  Google Scholar 

  • McDougal JN, Miller MS, Burks TF, Kreulen DL. Age-related change in colonic function in rats. American Journal of Physiology 247: G542–G546, 1984

    PubMed  CAS  Google Scholar 

  • McHugh SM, Diamant NE. Effect of age, gender and parity on anal canal pressures. Digestive Diseases and Sciences 32: 726–736, 1987

    Article  PubMed  CAS  Google Scholar 

  • Melkerssen M, Andersson H, Bosaeus I, Falkheden T. Intestinal transit time in constipated and nonconstipated geriatric patients. Scandinavian Journal of Gastroenterology 18: 593–597, 1983

    Article  Google Scholar 

  • Millon T, Green CJ, Meagher RB. Millon behavioral health inventory manual, 3rd ed, National Computer System, Minneapolis, 1982

    Google Scholar 

  • Milne JS, Williamson J. Bowel habit in older people. Gerontologia Clinica 14: 55–60, 1972

    Google Scholar 

  • Moore-Gillon V. Constipation: what does the patient mean? Journal of the Royal Society of Medicine 77: 108–110, 1984

    PubMed  CAS  Google Scholar 

  • Poisson J, Devroede G. Severe chronic constipation as a surgical problem. Surgical Clinics of North America 63: 193–217, 1983

    PubMed  CAS  Google Scholar 

  • Preston DM, Lennard-Jones JE. Anismus in chronic constipation. Digestive Diseases and Sciences 30: 413–418, 1985

    Article  PubMed  CAS  Google Scholar 

  • Read NW, Abouzekry L, Read MG, Howell P, Ottewell D, et al. Anorectal function in elderly patients with fecal impaction. Gastroenterology 89: 959–966, 1985

    PubMed  CAS  Google Scholar 

  • Read NW, Abouzekry L. Why do patients with faecal impaction have faecal incontinence? Gut 27: 283–287, 1986

    Article  PubMed  CAS  Google Scholar 

  • Read NW, Timms JM. Defecation and the pathophysiology of constipation. Clinics in Gastroenterology 15: 937–965, 1986

    PubMed  CAS  Google Scholar 

  • Ripstein CB. Procidentia: definitive corrective surgery. Diseases of the Colon and Rectum 15: 334–336, 1972

    Article  PubMed  CAS  Google Scholar 

  • Sandler RS, Jordan MC, Shelton BJ. Demographic and dietary determinants of constipation in the US population. Journal of Public Health 80: 185–189, 1990

    Article  CAS  Google Scholar 

  • Sekas G. The use and abuse of laxatives: recognizing the abusive patient. Practical Gastroenterology 11: 33–39, 1987

    Google Scholar 

  • Shorvon PJ, McHugh F, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut 30: 1737–1749, 1989

    Article  PubMed  CAS  Google Scholar 

  • Smith B. Pathologic changes in the colon produced by anthraquinone purgatives. Diseases of the Colon and Rectum 16: 455–458, 1973

    Article  PubMed  CAS  Google Scholar 

  • Snooks SJ, Henry MM, Swash M. Anorectal incontinence and rectal prolapse: Differential assessment of the innervation to puborectalis and external anal sphincter muscles. Gut 26: 470–476, 1985

    Article  PubMed  CAS  Google Scholar 

  • Szurszewski JH, Holt PR, Schuster M. Proceedings of a workshop entitled ‘Neuromuscular function and dysfunction of the gastrointestinal tract in aging.’ Digestive Diseases and Sciences 34: 1135–1146, 1989

    Article  PubMed  CAS  Google Scholar 

  • Talley NJ, O’Keefe EA, Zinsmeister AR, Melton LJ. Prevalence of gastrointestinal symptoms and functional bowel disorders in the elderly: a population-based study. Gastroenterology 102: 895–901, 1992

    PubMed  CAS  Google Scholar 

  • Tedesco FJ, DiPiro JT. Laxative use in constipation. American Journal of Gastroenterology 80: 303–309, 1985

    PubMed  CAS  Google Scholar 

  • Varma JS, Bradnock J, Smith RG, Smith AN. Constipation in the elderly: a physiologic study. Diseases of the Colon and Rectum 31: 111–115, 1988

    Article  PubMed  CAS  Google Scholar 

  • Wald A. Constipation and fecal incontinence in the elderly. Gastroenterology Clinics of North America 19: 405–418, 1990

    PubMed  CAS  Google Scholar 

  • Wald A, Caruana BJ, Freimanis MG, Bauman DH, Hinds JP. Contributions of evacuation proctography and anorectal manometry to the evaluation of adults with constipation and defecatory difficulty. Digestive Diseases and Sciences 35: 481–487, 1990

    Article  PubMed  CAS  Google Scholar 

  • Wald A, Hinds JP, Caruana BJ. Psychological and physiological characteristics of patients with severe idiopathic constipation. Gastroenterology 97: 932–937, 1989

    PubMed  CAS  Google Scholar 

  • Wells C. New operation for rectal prolapse. Proceedings of the Royal Society of Medicine 52: 602–603, 1959

    PubMed  CAS  Google Scholar 

  • Whitehead WE, Drinkwater D, Cheskin LJ, Heller BR, Schuster MM. Constipation in the elderly living at home: definition, prevalence and relationship to life style and health status. Journal of the American Geriatrics Society 37: 423–429, 1989

    PubMed  CAS  Google Scholar 

  • Wrenn K. Fecal impaction. New England Journal of Medicine 321: 658–662, 1989

    Article  PubMed  CAS  Google Scholar 

  • Yang P, Banwell JG. Dietary fibre: its role in the pathogenesis and treatment of constipation. Practical Gastroenterology 10: 28–32, 1986

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Arnold Wald

Authors
  1. Arnold Wald
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wald, A. Constipation in Elderly Patients. Drugs & Aging 3, 220–231 (1993). https://doi.org/10.2165/00002512-199303030-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199303030-00003

Keywords

Search

Navigation