Update on the management of constipation in the elderly: new treatment options.

Satish S.C. Rao, Jorge T. Go

Research output: Contribution to journalReview article

113 Citations (Scopus)

Abstract

Constipation disproportionately affects older adults, with a prevalences of 50% in community-dwelling elderly and 74% in nursing-home residents. Loss of mobility, medications, underlying diseases, impaired anorectal sensation, and ignoring calls to defecate are as important as dyssynergic defecation or irritable bowel syndrome in causing constipation. Detailed medical history on medications and co-morbid problems, and meticulous digital rectal examination may help identify causes of constipation. Likewise, blood tests and colonoscopy may identify organic causes such as colon cancer. Physiological tests such as colonic transit study with radio-opaque markers or wireless motility capsule, anorectal manometry, and balloon expulsion tests can identify disorders of colonic and anorectal function. However, in the elderly, there is usually more than one mechanism, requiring an individualized but multifactorial treatment approach. The management of constipation continues to evolve. Although osmotic laxatives such as polyethylene glycol remain mainstay, several new agents that target different mechanisms appear promising such as chloride-channel activator (lubiprostone), guanylate cyclase agonist (linaclotide), 5HT(4) agonist (prucalopride), and peripherally acting mu-opioid receptor antagonists (alvimopan and methylnaltrexone) for opioid-induced constipation. Biofeedback therapy is efficacious for treating dyssynergic defecation and fecal impaction with soiling. However, data on efficacy and safety of drugs in elderly are limited and urgently needed.

Original languageEnglish (US)
Pages (from-to)163-171
Number of pages9
JournalClinical interventions in aging
Volume5
StatePublished - 2010

Fingerprint

Constipation
Rectal Diseases
Defecation
alvimopan
prucalopride
Fecal Impaction
Independent Living
Therapeutics
Digital Rectal Examination
Laxatives
Narcotic Antagonists
Hypesthesia
Irritable Bowel Syndrome
mu Opioid Receptor
Guanylate Cyclase
Manometry
Hematologic Tests
Colonoscopy
Nursing Homes
Colonic Neoplasms

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Update on the management of constipation in the elderly : new treatment options. / Rao, Satish S.C.; Go, Jorge T.

In: Clinical interventions in aging, Vol. 5, 2010, p. 163-171.

Research output: Contribution to journalReview article

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