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Constipation Treatments Not Equally Effective: Review

MONDAY Jan. 28, 2013 -- Some treatments are more effective than others for relieving constipation in seniors, according to a new review.

And laxatives aren't always enough, researchers say.

Constipation is common in seniors and can have serious health consequences and affect quality of life. Excessive straining in frail elderly people can cause them to faint and put them at risk of injury or falling, or restrict blood flow to the heart and brain.

Chronic constipation can lead to fecal impaction, a large lump of hard stool that remains stuck in the rectum. Fecal impaction can cause nausea, pain and loss of appetite.

"Given the growing proportion of older adults in North America, effective management of constipation by health care professionals will be increasingly necessary," Dr. Dov Gandell, of Sunnybrook Health Sciences Centre in Toronto, and colleagues wrote in an article appearing Jan. 28 in the CMAJ (Canadian Medical Association Journal).

The authors reviewed the latest evidence on the effectiveness and safety of treatments for constipation in seniors and found that osmotic agents such as polyethylene glycol and lactulose are effective in increasing the secretion of water in the colon. These agents (especially lactulose), however, can cause gas, bloating and diarrhea, according to a journal news release.

Soluble fibers, such as psyllium are often used to treat constipation, but the researchers found strong evidence for their effectiveness. Naturally derived stimulant laxatives such as senna and cascara have been shown to be helpful but may become less effective with long-term use.

Although increased fluid intake and exercise were not shown to be effective ways to relieve constipation, they do provide other health benefits and are recommended for seniors, according to the review authors.

They outlined a nine-step process to help doctors manage seniors with constipation. It includes: identifying symptoms and possible secondary causes; confirming or ruling out fecal impaction; improving lifestyle behaviors; modifying diet; and trying various laxatives.

If these and other initial steps are unsuccessful, patients should be referred to a gastroenterologist or geriatrician, the researchers recommended.

"Physicians should educate their patients on the wide range of normal bowel habits and the potential benefits of dietary modifications to improve symptoms," they concluded.

More information

The U.S. National Institute on Aging has more about constipation.

Posted: January 2013


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