Summary
Constipation is one of the most common digestive complaints. It is a symptom, not a disease. The subjectivity that this involves means that assessments of clinical epidemiology, socioeconomic costs and pharmacotherapy are difficult, since there is no definition of ‘normal’ bowel habit. Although constipation can affect all ages, the problem increases with age, and is of particular concern for those who are frail and in long term care. Cultural influences may affect the prevalence in older people.
Drug therapy of constipation cannot be considered in isolation, since there are issues in the prevention of constipation and the principles of good management that also apply. Furthermore, some consideration of the pathophysiology and diagnosis is important. This is because a number of remediable causes can be identified, and the diagnostic process involves patient education, which in turn may be effective in reducing costs.
It is the complaint of constipation which leads either to self–medication or to consultation with the medical profession. Both of these courses of action have a significant influence on utilisation of laxatives (cathartics), obtained both overthe–counter and by prescription. Although there are a large number of laxative preparations available, therapy has changed little in half a century. Costs may vary considerably, and with such a significant problem there is a need for comparative studies. However, study methodologies are difficult, and a significant placebo response may be found. Education and preventive measures have been shown to reduce laxative use and costs in institutions. Unfortunately, there are few comparative studies of individual laxatives and even fewer cost–effectiveness studies. Those that there are have been based in institutions, and so extrapolation to other situations may be difficult.
In general, little attention is given to constipation. It is, however, an area with significant resource implications in which education and preventive measures have been shown to be beneficial. Even so, there is still a need for good comparative studies, particularly where cost effectiveness is concerned.
Similar content being viewed by others
References
Castle SC. Constipation: endemic in the elderly? Med Clin North Am 1989; 73: 1497–509
Tremaine WJ. Chronic constipation: causes and management. Hosp Pract 1990; 30: 89–1 DO
Harari D, Gurwitz JH, Minaker KL. Constipation in the elderly. J Am Geriatr Soc 1993; 41: 1130–40
Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectum 1989; 32: 1–8
Current estimates from the National Health Interview Survey: United States 1982–1985. Hyattsville, Maryland: National Center for Health Statistics/US Public Health Service, 198586. Vital and health statistics, series IO, numbers 150, 154 1985
Sonnenberg A, Koch TR. Physician visits in the United States for constipation: 1958–1986. Dig Dis Sci 1989; 34: 606–11
Johansen JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol 1989; 11: 525–36
Sandler RS, Drossman DA. Bowel habits in young adults not seeking health care. Dig Dis Sci 1987; 32: 841–5
Thompson WG, Heaton KW. Functional bowel disorders in apparently healthy people. Gastroenterology 1980; 79: 283–8
Sandler RS, Jordan MC, Shelton BJ. Demographic and dietary determinants of constipation in the US population. Am J PublicHealth 1990; 80: 185–9
Donald IP, Smith RG, Cruikshank JG, et al. A study of constipation in the elderly living at home. Gerontology 1985; 31: 112–8
Whitehead WE, Drinkwater D, Cheskin LJ, et al. Constipation in the elderly living at home: definition, prevalence and relationshipto lifestyle and health status. J Am Geriatr Soc 1989; 37: 423–9
Connell AM, Hilton C, Irvine G, et al. Variation of bowel habit in two population samples. BMJ 1965; 6: 1095–9
Milne JS, Williamson J. Bowel habits in older people. Gerontol Clin 1972; 14: 56–60
Kinnunen O. Study of constipation in a geriatric hospital, day hospital, old people’s home and at home. Aging 1991; 3: 161–70
Loening-Baucke V, Anuras S. Sigmoidal and rectal motility in healthy elderly. J Am Geriatr Soc 1984; 32: 887–91
Brocklehurst JC, Kirkland JL, Martin J, et al. Constipation in long–stay elderly patients: its treatment and prevention bylactulose, poloxalkol—dihydroxyanthroquinolone and phosphateenemas. Gerontology 1983; 29: 181–4
Eastwood HDH. Bowel transit studies in the elderly; radioopaque markers in the investigation of constipation. GerontolClin 1972; 14: 154–9
Lennard Jones JE. Clinical management of constipation. Pharmacology 1993; 47 Suppl. l: 216–23
Starreveld JS, Pols MA, Van Wijk HJ, et al. The plain abdominal radiograph in the assessment of constipation. Z Gastroenterol 1990; 28: 335–8
Wald A. Constipation in elderly patients. Drugs Aging 1993; 3: 220–31
Snustad D, Lee V, Abraham I, et al. Dietary fiber in hospitalized elderly patients: too soft a solution for too hard a problem? JNutr Elderly 1991; 1O: 49–63
Muller-Lisner SA. Effect of wheat bran on the weight of stool and gastrointestinal transit time: a meta analysis. BMJ 1988; 296: 615–7
Royal College of GeneraI Practitioners, Office of Population Censuses and Surveys, Department of Health and Social Security. Morbidity statistics from generaI practice 1981–1982:third national study. London: Her Majesty’s Stationery Office, 1986. Studies on medical and population subjects; series MB5, no. l
Glaser M, Chi J. Thirty fifth annual report on consumer spending. Drug Topics 1983 July 4: 18–20
Bateman DN. Management of constipation. Prescr J 1991; 31: 7–15
Heaton KW, Cripps HA. Straining at stool and laxative taking in an English population. Dig Dis Sci 1993; 38: 1004–8
Read NW, Abouzekry L, Read MG, et al. Anorectal function in elderly patients with fecal impaction. Gastroenterology 1985; 89: 959–66
Geboes K, Bossaert H. Gastrointestinal disorders in old age. Age Ageing 1977; 6: 197–200
Passmore AP, Wilson-Davies K, Stoker C, et al. Chronic constipation in long stay elderly patients: a comparison of lactuloseand a senna—fibre combination. BMJ 1993; 307: 769–71
Wesselius-de Casparis W, Braadbart S, Bergh-Bohlken GE, et al. Treatment of chronic constipation with lactulose syrup:results of a double blind study. Gut 1968; 9: 84–6
Maclennan WJ, Pooler AWFM. A comparison of sodium picosulphate (Iaxoberal) with standardised senna (senokot) ingeriatric patients. Curr Med Res Opin 1975; 2: 641–7
Tedesco FJ, Dipiro JT. Laxative use in constipation. Am J Gastroenterol 1985; 80: 303–9
Anon. Laxatives: replacing Danthron. Drug Ther Bull 1988; 26: 53–6
Kot TV, Pettit-Young NA. Lactulose in the management of constipation: a current review. Ann Pharmacother 1992; 26: 1277–82
Elzarian EJ, Shirachi DY, Jones JK. Educational approaches promoting optimal laxative use in long—term—care patients. J Chronic Dis 1980; 33: 613–26
Hull C, Greco RS, Brooks DL. Alleviation of constipation in the elderly by dietary fiber supplementation. J Am Geriatr Soc 1980; 28: 410–4
Valle-Jones JC. An open study of oat bran meal biscuits (‘Lejfibre’) in the treatment of constipation in the elderly. Curr Med Res Opin 1985; 9: 716–20
Pringle R, Pennongton MJ, Pennington CR, et al. A study of the influences of a fiber biscuit on bowel function in the elderly. Age Ageing 1984; 13: 175–8
Brocklehurst JC, Khan MY. A study of faecal stasis in old age and the use of ‘Dorbanex’ in its prevention. Gerontol Clin 1969; 1l: 293–300
Fintelmann V, Haase W. Chronic habitual constipation: double blind trial of a laxative of known efficacy. Arzt J Praxis 1977; 29: 25–6
Sanders JE. Lactulose syrup assessed in a double blind study of elderly constipated patients. J Am Geriatr Soc 1978; 26: 236–9
Champion MC, Thompson WG, Kilgour JA, et al. Efficacy and cost effectiveness of lactulose in the treatment of constipationin elderly psychiatric patients: a double–blind placebo–controlledcross–over study [abstract]. Am J Gastroenterol 1986; 81: 872
Donowitz M, Binder HJ. Effect of dioctyl sodium sulfosuccinate in colonic fluid and electrolyte movement. Gastroenterology 1975; 69: 941–50
Wilson JL, Dickinson DG. Use of dioctyl sodium sulfosuccinate (aerosol OT) for severe constipation. JAMA 1955; 158: 261–3
Rouse M, Chapman N, Mahapatra M, et al. An open, randomised, parallel group study of lactulose versus ispaghula inthe treatment of chronic constipation in adults. Br J Clin Pract 1991; 45: 28–30
Lederle FA, Busch DL, Mattox KM, et al. Cost–effective treatment of constipation in the elderly: a randomised doubleblindcomparison of sorbitol and lactulose. Am J Med 1990; 89: 597–601
Marlett JA, Li BUK, Patrow CJ, et al. Comparative laxation of psyllium with and without senna in an ambulatory constipatedpopulation. Am J Gastroenterol 1987; 82: 333–7
Raphael JH. Constipation in the elderly — a new treatment. Gerontol Clin 1966; 8: 160–3
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Passmore, A.P. Economic Aspects of Pharmacotherapy for Chronic Constipation. Pharmacoeconomics 7, 14–24 (1995). https://doi.org/10.2165/00019053-199507010-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199507010-00003