Constipation when we age

Chronic constipation (CC) is a prevalent issue among the elderly, affecting up to 30% of individuals over 60 years old. This condition significantly impacts their quality of life, causing discomfort and potentially leading to complications like fecal impaction or rectal prolapse.

Causes and Risk Factors

Age-related changes in colonic motility, reduced physical activity, poor dietary habits, and insufficient hydration contribute to constipation. Chronic medical conditions like diabetes, hypothyroidism, and neurological disorders, along with medications such as opioids and anticholinergics, further exacerbate the problem.

Symptoms and Diagnosis

CC is characterized by infrequent bowel movements, hard stools, and a sense of incomplete evacuation. The Rome IV criteria are often used for diagnosis. Alarm signs, such as rectal bleeding or significant weight loss, warrant further investigation with tests like colonoscopy or anorectal manometry.

Management Strategies

Management involves a stepwise approach:

1. Lifestyle Modifications: Encouraging a fiber-rich diet (25–30g daily), adequate hydration, and moderate exercise.

2. Medications: Osmotic laxatives (e.g., polyethylene glycol) and stimulants (e.g., bisacodyl) are commonly used. Newer agents like prucalopride or lubiprostone may be prescribed for refractory cases.

3. Pelvic Floor Training: Biofeedback therapy is effective for defecatory disorders.

For severe cases, enemas or suppositories may be necessary, though surgical interventions are rarely recommended due to their risks.

Conclusion

Chronic constipation in the elderly requires timely diagnosis and a tailored treatment plan. Addressing lifestyle factors and optimizing medical management can alleviate symptoms, improving overall well-being. Early intervention by healthcare providers is crucial to minimize the impact of this condition on older adults.