Constipation

Author: Suchitra Kamineni, MD

Key Points

Constipation can be a difficult problem to manage.

It is estimated that the prevalence of constipation in North American adults ranges from 2-27 percent and in older adults 24 to 50 percent (Fox-Orenstein, McNally & Odunai, 2008; Talley, 2004).

Laxatives are used daily by 10 to 18 percent of community dwelling older adults and 74 percent of nursing home residents (Ruby, Fillenbaum, Kuchibhatia, & Hanlon, 2003). 

 

Overview

Primary or idiopathic constipation can be categorized as: Secondary etiologies for constipation are:

 

Assessment

Detailed history about bowel habits, medication use, hypothyroidism, back trauma or neurologic problems (multiple sclerosis, spinal cord injury), psychiatric disorders and recent immobility.

Perianal inspection for scars, fistulas, fissures, hemorrhoids.

Rectal exam to palpate for mass, stricture, or stool impaction, also note sphincter tone.

 

Diagnosis

Patient without alarm symptoms: Patient with alarm symptoms or patient is ≥ 50 years old, additionally consider

 

Intervention

Non-pharmacological treatment: Pharmacological treatment: Opioid Induced Constipation:

 

Prevention

Laxative prophylaxis may prevent constipation in critically ill ventilated patients (Masri, Abubaker & Ahmed, 2010).

Health care providers should consider the following when their patient is taking opioid analgesics:

In older adults, if feasible avoid medications that contribute to constipation, such as, anticholinergics, tricyclic antidepressants, iron, calcium, verapamil.

 

References

Barish, C.F., Drossman, D., Johanson, J.F., & Ueno, R. (2010). Efficacy and safety of lubiprostone in patients with chronic constipation. Digestive Diseases Science: 55(4):1090‐1097. Epub 2009 Dec 11.

Dukas, L., Willett, W.C., Giovannucci, E.L. (2003). Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. American Journal of Gastroenterology;98:1790-1796.

Foxx-Orenstein, A.E., McNally, M.A., Odunsi, S.T. (2008). Cleveland Clinic Journal of Medicine; 75(11):813-24.

Lamas, K., Lindholm, L. Stenlund, H., Engstrom, B., & Jacobsson, C. (2009). Effects of abdominal massage in management of constipation--a randomized controlled trial. International Journal of Nursing Studies:46(6): 559-567.

Lembo, A. & Camilleri, M. (2003). Chronic constipation. New England Journal of Medicine: 349(14):1360–1368.

Masri, Y. Abubaker, J., Ahmed, R. (2010). Prophylaxation use of laxative for constipation in critically ill patient. Annual Thoracic Medicine5(4): 228-231.

Rao, S.S. (2003). Constipation: Evaluation and treatment. Clinics of North American;32(2):659-683.

Ruby, C.M., Fillenbaum, G.G., Kuchibhatla, M.N., Hanlon, J.T. ( 2003). Laxative use in community dwelling elderly. American Journal Geriatric Pharmacotherapeutics; 1(1):11-17.

Talley, N.J. (2004). Definitions, epidemiology and impact of chronic constipation. Review Gastroenterology Disorders, 4: Supplement 2: S3-S10

Ternent, C.A., Bastawrous, A.L., Morin, N.A., Ellis, C.N., Hyman, N.H., & Buie, W.D. (2007). Practice parameters for the evaluation and management of constipation. Diseases of Colon and Rectum: 50(12):2013-22.

Ishihara M, Ikesue H, Matsunaga H, Suemaru K, Kitaichi K, Suetsugu K, Oishi R, Sendo T, Araki H, (2012). A multi-institutional study analyzing effect of prophylactic medication for prevention of opioid-induced gastrointestinal dysfunction. Clinical Journal of Pain;28(5):373-81. doi: 10.1097/AJP.0b013e318237d626.