Constipation, which increases with age, is a common complaint in seniors that can have serious health consequences and affect quality of life. Excessive straining in frail people can cause fainting and the risk of injury from falling or restrict blood flow to the heart and brain. Fecal impaction can cause nausea, loss of appetite and pain, which can lead to functional decline.
"Given the growing proportion of older adults in North America, effective management of constipation by health care professionals will be increasingly necessary," writes Dr. Dov Gandell, Sunnybrook Health Sciences Centre, Toronto, with coauthors.
Constipation can be caused by medications such as opioids and iron pills as well as metabolic conditions and diseases, although the main cause of the condition is not well understood.
Evidence from randomized controlled trials indicates that the use of osmotic agents such as polyethylene glycol and lactulose are effective in increasing the secretion of water in the colon, although these agents (especially lactulose) can cause bloating, gas and diarrhea. Soluble fibres such as psyllium are often used, although there is not strong evidence for effectiveness. Stimulant laxatives, such as senna and cascara which are naturally derived, have been shown to be effective but may become less effective with long-term use.
Increased fluid intake and exercise were not shown to alleviate constipation but should be undertaken for other health benefits.
The authors recommend a 9-step process to help patients manage constipation, which includes identifying symptoms and possible secondary causes, verifying or excluding impaction, optimizing behaviour, modifying diet and undergoing trials of various laxatives. Referral to a gastroenterologist or geriatrician would be the final step if the previous steps were unsuccessful.
"The symptoms [of constipation] can have a profound impact on quality of life and in certain circumstances may lead to functional decline," state the authors. "Physicians should educate their patients on the wide range of normal bowel habits and the potential benefits of dietary modifications to improve symptoms."
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