Special Patient Groups

Constipation in older adults

• Constipation is common in older adults.

Fecal impaction is common in older adults and can manifest atypically with paradoxical diarrhea (due to decreased rectal sensation) and nonspecific symptoms (e.g., functional decline, delirium)

Treatment

• Manage fecal impaction

• Lifestyle modifications: similar to management in all adults (see “Nonpharmacological management of constipation” above), with some special considerations

  • Fiber supplementation: Older adults are more likely to need fiber supplements to reach their daily fiber goals.

  • Fluid intake

    • Consider fluid-sensitive comorbidities (e.g., CHF, CKD), which are more common in older adults.

    • Assess and optimize the patient's ability to communicate and/or access their fluid needs.

  • Bowel habits: Discourage defecation in bedpans.

  • Physical activity: Increased exercise does not decrease constipation in older patients diagnosed with constipation.

• Laxatives

  • Required in most older adults with chronic constipation

  • Therapy should be individualized; see “Overview of laxatives” .

    • Preferred first-line agent: polyethylene glycol