February 13, 2013
Constipation in the Elderly: What Works and What Doesn’t

Toronto—Constipation, while uncomfortable for everyone, can be especially a problem for the elderly, according to a recent review looking at the best therapies for the common problem.

Background information in the review notes that constipation can have serious health effects in the elderly who, for example, can faint from excessive straining. Fecal impaction, meanwhile, can cause nausea, loss of appetite, and pain, all of which can lead to functional decline.

The article, published recently in CMAJ (Canadian Medical Association Journal) suggests that osmotics, such as polyethylene glycol and lactulose, are effective in treating constipation in older patients, but that some commonly recommended therapies are either not effective or can lose potency over the long term.

“Given the growing proportion of older adults in North America, effective management of constipation by health care professionals will be increasingly necessary,” write the authors from Sunnybrook Health Sciences Centre in Toronto.

Polypharmacy also is more common with older patients, and constipation can be the side effect of medications such as opioids and iron supplements.

The authors report that while osmotics are effective in alleviating the problem, therapies such as lactulose also can cause bloating, gas, and diarrhea.

As for other remedies, they note:

• While often used, there is no strong evidence for the effectiveness of soluble fibers such as psyllium;
• Naturally derived stimulant laxatives, such as senna and cascara, may initially be effective but become less so with longer term use;
• Exercising and drinking more water, while they have other health benefits, appeared to have little role in alleviating constipation.

Overall, according to the review, “Evidence supporting the use of bulk agents, stool softeners, stimulants, and prokinetic agents was lacking, limited, or inconsistent.”

Noting that constipation can have a “profound impact on quality of life” in the elderly, the authors emphasize the importance of educating patients on the “wide range of normal bowel habits and the potential benefits of dietary modifications to improve symptoms.”

U.S. Pharmacist Social Connect