Constipation in elderly patients. Pathogenesis and management

The incidence of constipation appears to increase with increasing age, particularly after the age of 65. There are few data on the age-related physiological changes of colonic and anorectal function; however, anal sphincter pressures are decreased in elderly patients, while colonic transit time does not appear to be altered. The successful management of constipation in elderly patients requires an understanding of colorectal function, careful characterisation of the patient's complaint, and in selected patients, specialised studies of colonic and anorectal function. The cause of constipation in elderly patients is often multifactorial and may include inactivity, inappropriate diet, depression and confusion, certain medications, and neuromuscular disorders. The treatment of chronic constipation should be based on the nature of the complaint and the presumed pathophysiological mechanisms at work in each patient. Treatment will be based on one or more strategies including dietary changes, laxatives, and in carefully defined cases, surgery.