B5.063 Constipation in the Elderly

Question 1

prevalence of constipation in the elderly

Answer 1

30% in those over 60 (all adults only 16%)
50% in community dwelling elderly
70% in nursing homes

Question 2

epidemiology of constipation

Answer 2

more frequent in women and lower socioeconomic populations

Question 3

complications of constipation in the elderly

Answer 3

hemorrhoids
fecal impaction/ incontinence
urinary incontinence
stercoral ulcers
acute delirium
rectal prolapse
volvulus
ER visits or hospitalizations

Question 4

physician definition of constipation

Answer 4

infrequent bowel movements, usually <3 per week for at least 3 of last 12 months

Question 5

patient symptoms of constipation

Answer 5

hard stools
incomplete evacuation
ab discomfort
bloating and distention
excessive straining
sense of blockage
manual maneuvers needed

Question 6

4 classes of primary constipation

Answer 6

functional constipation
outlet dysfunction
slow transit constipation
combination

Question 7

functional constipation

Answer 7

idiopathic constipation meeting ROME 4 criteria
multi regional intestinal dysmotility
Bristol stool scale

Question 8

outlet obstruction

Answer 8

lack of coordination between ab muscle contraction and pelvic floor muscle relaxation resulting in straining
obstructed perineal transit due to anorectal structural abnormalities or urogynecological diseases

Question 9

slow transit constipation

Answer 9

alterations in enteric neurons and glial cells
depletion of ICC pacemaker cells
colonic structural abnormalities
increased collagen in ascending colon
reduction of high amplitude propagated contractions (<5 per day)
deficient gastro-colic reflex

Question 10

sources of secondary constipation

Answer 10

diet
meds
underlying conditions (hypothyroidism, DM, parkinsons)
systemic diseases
psych disorders
endocrine disorders
electrolyte abnormalities
sedentary lifestyle

Question 11

examples of meds that can aggravate constipation

Answer 11

calcium supplements
fiber supplements
narcotic analgesics

Question 12

is constipation a consequence of normal aging?

Answer 12

nah

Question 13

treatment approach for constipation in the elderly

Answer 13

identify cause and select appropriate agent/agents to treat it
diet/lifestyle often ineffective, need multifactorial approach
laxative mainstay