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). 



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



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.



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



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



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.



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