Chronic Constipation in the Elderly
Year: 2025
Type: article
Abstract: INTRODUCTION Constipation is a term used to describe when you have three or fewer bowel movements in a week. It can also be used to describe a feeling when one is unable to empty bowels completely or they need to strain for a bowel movement. About 16 percent of adults experience chronic constipation. Chronic constipation is a common problem in the elderly population affecting their quality of life and health. Types of constipation: Primary Secondary. Factors contributing to constipation Physiological changes Aging leads to reduced gastrointestinal motility, resulting in slower transit time and increased water absorption from the stool, leading to harder stools which makes passage of stools difficult.[1] Dietary factors Insufficient fiber intake is a common issue. In some people, milk and dairy may contribute to constipation.[2] Fluid Intake People in the elderly age group either have a reduced water intake or have associated comorbidities such as cardiac or renal disease which limit their water intake, thus leading to constipation.[3] Physical Inactivity Sedentary lifestyle and immobility due to osteoarthritis of the knee or neurological conditions result in decreased bowel motility which leads to constipation. Medications The elderly age group are usually on multiple medications for different medical problems such as analgesics (opioids), diuretics, anticholinergics, calcium channel blockers, antiparkinsonian drugs, iron supplements, and calcium supplements that can reduce bowel motility, and less water in the bowel leads to constipation.[4] Medical conditions Neurological disorders (Parkinson’s disease, stroke, and spinal cord disorders) and metabolic conditions (hypothyroidism and diabetes mellitus) can impair bowel function. Chronic kidney disease and congestive heart failure due to fluid restriction can cause the passage of dry hard stools. Psychological and behavioral factors Due to depression and anxiety in old age, there is a tendency for reduced physical activity and improper food and water intake; this results in constipation. Complications of constipation Hemorrhoids anal fissure rectal prolapse fecal impaction.[1,5]Elderly should always look out for alarm signs such as recent onset of constipation, change in bowel habits, and bleeding per rectum which can point toward malignancy and should be urgently brought to the attention of a doctor.MANAGEMENT Dietary modifications A high-fiber diet (20–30 g of dietary fiber daily) comprising fruits, vegetables, and whole grains can be incorporated into the diet to alleviate symptoms of constipation. Avoid processed foods.[2] Hydration Adequate fluid intake is crucial for the normal population. However, people with heart or kidney diseases should consult their physician first as they have fluid restriction in certain cases.[3] Physical activity and sleep Exercise increases bowel motility, reduces stress, and helps to decrease constipation and irritable bowel syndrome - constipation type. Pelvic floor exercises and squatting positions are helpful for proper bowel movement and provide relief in constipation. Adequate sleep reduces stress and anxiety. Scheduled toileting People should be advised to sit in the washroom for a specific duration like 5 min, without the use of mobile phones and twice a day preferably; this helps to establish regular bowel habits.[1] Medicines Pharmacological intervention is needed if there is no improvement in constipation after lifestyle modifications. Pharmacological agents should always be taken after a doctor’s consultation.[4,6] Commonly used agents are: Polyethylene glycol, lactulose, milk of magnesia, and isabgol husk In India, many people take herbal medications which contain senna or over-the-counter available drugs such as bisacodyl which are habit-forming agents People should be made aware about risks and benefits for the same. Henceforth, it is important that medication should always be taken after consulting a physician. CONCLUSION Constipation is a multifactorial problem requiring a multipronged approach. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Authors: Raghavender Puri, Rajesh Puri
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411763353