Chronic constipation in the elderly: a primer for the gastroenterologist.

Roberto De Giorgio,Giuseppe Chiarioni,Franco Bazzoli,Leonardo H Eusebi,Vincenzo Stanghellini,Eugenio Ruggeri

doi:10.1186/s12876-015-0366-3

Abstract

Constipation is a frequently reported bowel symptom in the elderly with considerable impact on quality of life and health expenses. Disease-related morbidity and even mortality have been reported in the affected frail elderly. Although constipation is not a physiologic consequence of normal aging, decreased mobility, medications, underlying diseases, and rectal sensory-motor dysfunction may all contribute to its increased prevalence in older adults. In the elderly there is usually more than one etiologic mechanism, requiring a multifactorial treatment approach. The majority of patients would respond to diet and lifestyle modifications reinforced by bowel training measures. In those not responding to conservative treatment, the approach needs to be tailored addressing all comorbid conditions. In the adult population, the management of constipation continues to evolve as well as the understanding of its complex etiology. However, the constipated elderly have been left behind while gastroenterology consultations for this common conditions are at a rise for the worldwide age increment. Aim of this review is to provide an update on epidemiology, quality of life burden, etiology, diagnosis, current approaches and limitations in the management of constipation in the older ones to ease the gastroenterologists’ clinic workload.

Highlights

Chronic constipation is the prototype of functional gastrointestinal disorders (FGID) and a condition frequently encountered in clinical practice, both in specialty office and in general medicine
Data are limited to a single randomized controlled trial (RCT) reporting on clinical and anorectal physiology benefit associated with EMG-biofeedback treatment in 15 elderly patients with dyssynergia when compared to an analogue control group [61]
In recent RCTs both bisacodyl and sodium picosulfate proved effective on increasing the number of complete spontaneous bowel movements/week compared to placebo in constipated adults, but data in the elderly are lacking [62]

Summary

Introduction

Chronic constipation is the prototype of functional gastrointestinal disorders (FGID) and a condition frequently encountered in clinical practice, both in specialty office (e.g., gastroenterology, geriatrics) and in general medicine.About 30 % of the general population experiences problems with constipation during life time [1, 2], with elderly people and women being mostly affected. Data are limited to a single RCT reporting on clinical and anorectal physiology benefit associated with EMG-biofeedback treatment in 15 elderly patients with dyssynergia when compared to an analogue control group [61].

Results

Conclusion