Constipation in Older Adults: Pathophysiology, Clinical Impact, and Management Strategies

Area of Science:

• Geriatric Medicine
• Gastroenterology
• Internal Medicine

Background:

• Constipation is a prevalent gastrointestinal issue in older adults, impacting quality of life and functional status.
• Its multifactorial causes include aging, comorbidities, and polypharmacy, often viewed narrowly as a localized disorder.
• A geriatric syndrome framework is proposed to capture its broader systemic implications in the elderly.

Purpose of the Study:

• To propose and evaluate constipation in older adults as a "systemic geriatric syndrome" using a three-criterion definition.
• To integrate multifactorial pathogenesis, links to functional decline/frailty, and systemic adverse outcomes.
• To assess existing evidence against this proposed framework.

Main Methods:

• A narrative literature search was performed on PubMed for studies published between January 2023 and December 2025.
• Search terms included "Constipation" [Major Topic] and "Aged" [MeSH Terms].
• Included were English-language original studies, systematic reviews, and clinical/epidemiological studies of individuals aged 65 years and older.

Main Results:

• Constipation diagnosis in the elderly is complex due to secondary causes and atypical presentations.
• Pathophysiology involves gut motility, neural dysfunction, and microbiota changes, potentially promoting inflammation.
• Factors like inactivity, sarcopenia, dehydration, and polypharmacy interact via the brain-gut-microbiota axis, affecting systemic health, frailty, and cognition.

Conclusions:

• Evidence supports classifying constipation in older adults as a systemic geriatric syndrome.
• Further longitudinal and mechanistic research is needed for formal validation.
• Comprehensive management beyond laxatives is crucial for preserving functional health and reducing complications in aging populations.