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Management of Constipation in Older Adults.

Abstract

Chronic constipation is common in adults older than 60 years, and symptoms occur in up to 50% of nursing home residents. Primary constipation is also referred to as functional constipation. Secondary constipation is associated with chronic disease processes, medication use, and psychosocial issues. Fecal impaction should be treated with mineral oil or warm water enemas. Most patients are initially treated with lifestyle modifications, such as scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake. Additional fiber intake in the form of polycarbophil, methylcellulose, or psyllium may improve symptoms. Fiber intake should be slowly increased over several weeks to decrease adverse effects. The next step in the treatment of constipation is the use of an osmotic laxative, such as polyethylene glycol, followed by a stool softener, such as docusate sodium, and then stimulant laxatives. Long-term use of magnesium-based laxatives should be avoided because of potential toxicity. If symptoms do not improve, a trial of linaclotide or lubiprostone may be appropriate, or the patient may be referred for further diagnostic evaluation. Peripherally acting mu-opioid antagonists are effective for opioid-induced constipation but are expensive.

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  • Authors+Show Affiliations

    ,

    University of North Carolina, Chapel Hill, NC, USA.

    ,

    University of North Carolina, Chapel Hill, NC, USA.

    University of North Carolina, Chapel Hill, NC, USA.

    Source

    American family physician 92:6 2015 Sep 15 pg 500-4

    MeSH

    Aged
    Aged, 80 and over
    Chronic Disease
    Constipation
    Education, Medical, Continuing
    Female
    Humans
    Male
    Middle Aged
    Practice Guidelines as Topic
    United States

    Pub Type(s)

    Journal Article
    Patient Education Handout

    Language

    eng

    PubMed ID

    26371734

    Citation

    Mounsey, Anne, et al. "Management of Constipation in Older Adults." American Family Physician, vol. 92, no. 6, 2015, pp. 500-4.
    Mounsey A, Raleigh M, Wilson A. Management of Constipation in Older Adults. Am Fam Physician. 2015;92(6):500-4.
    Mounsey, A., Raleigh, M., & Wilson, A. (2015). Management of Constipation in Older Adults. American Family Physician, 92(6), pp. 500-4.
    Mounsey A, Raleigh M, Wilson A. Management of Constipation in Older Adults. Am Fam Physician. 2015 Sep 15;92(6):500-4. PubMed PMID: 26371734.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Management of Constipation in Older Adults. AU - Mounsey,Anne, AU - Raleigh,Meghan, AU - Wilson,Anthony, PY - 2015/9/16/entrez PY - 2015/9/16/pubmed PY - 2015/9/16/medline SP - 500 EP - 4 JF - American family physician JO - Am Fam Physician VL - 92 IS - 6 N2 - Chronic constipation is common in adults older than 60 years, and symptoms occur in up to 50% of nursing home residents. Primary constipation is also referred to as functional constipation. Secondary constipation is associated with chronic disease processes, medication use, and psychosocial issues. Fecal impaction should be treated with mineral oil or warm water enemas. Most patients are initially treated with lifestyle modifications, such as scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake. Additional fiber intake in the form of polycarbophil, methylcellulose, or psyllium may improve symptoms. Fiber intake should be slowly increased over several weeks to decrease adverse effects. The next step in the treatment of constipation is the use of an osmotic laxative, such as polyethylene glycol, followed by a stool softener, such as docusate sodium, and then stimulant laxatives. Long-term use of magnesium-based laxatives should be avoided because of potential toxicity. If symptoms do not improve, a trial of linaclotide or lubiprostone may be appropriate, or the patient may be referred for further diagnostic evaluation. Peripherally acting mu-opioid antagonists are effective for opioid-induced constipation but are expensive. SN - 1532-0650 UR - https://www.unboundmedicine.com/medline/citation/26371734/full_citation L2 - http://www.aafp.org/link_out?pmid=26371734 DB - PRIME DP - Unbound Medicine ER -