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Constipation in the elderly

D Harari1, J H Gurwitz, K L Minaker

  • 1Division on Aging, Harvard Medical School, West Roxbury, Massachusetts.

Journal of the American Geriatrics Society
|October 1, 1993
PubMed
Summary
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True constipation is not more common in the elderly, despite increased self-reported symptoms and laxative use. Aging does not inherently cause physiological changes leading to constipation.

Area of Science:

  • Geriatrics
  • Gastroenterology
  • Clinical Pharmacology

Background:

  • Constipation is a common complaint among the elderly.
  • Distinguishing between subjective and true clinical constipation is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To differentiate true clinical constipation from the subjective complaint of constipation in the elderly.
  • To review the pathophysiology, symptoms, diagnosis, causes, and treatment of constipation in older adults.

Main Methods:

  • Comprehensive literature search (MEDLINE, Index Medicus) of English-language studies.
  • Inclusion of physiological, cohort, case-control studies, and clinical trials.
  • Exclusion of management strategies based solely on uncontrolled clinical observations.

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Main Results:

  • Self-reported constipation and laxative use increase with age, but true clinical constipation does not show a similar escalation.
  • Normal aging does not cause physiological changes predisposing to constipation; prolonged transit and reduced rectal tone are condition-specific.
  • Evidence for risk factors and non-pharmacological interventions is limited; laxative trial interpretations require caution due to study limitations.

Conclusions:

  • True clinical constipation is not an inevitable consequence of aging.
  • Physiological changes associated with constipation are condition-specific, not age-related.
  • While many suspected risk factors and treatments lack robust evidence, a practical approach to elderly constipation can be formulated.