From the Guidelines
Chronic constipation in older men is commonly caused by a combination of factors, including decreased physical activity, inadequate fluid and fiber intake, certain medications, and age-related changes in the digestive system, with the most recent evidence suggesting that lifestyle changes and pharmacological management can effectively address this issue 1.
Causes of Chronic Constipation
The causes of chronic constipation in older men can be multifaceted, including:
- Decreased physical activity
- Inadequate fluid and fiber intake
- Certain medications, such as opioid pain relievers, anticholinergics, calcium channel blockers, iron supplements, and some antidepressants
- Neurological conditions, like Parkinson's disease
- Medical conditions, such as diabetes, hypothyroidism, and colorectal disorders like diverticulosis
- Age-related changes in the digestive system, including weakened abdominal muscles and decreased intestinal motility
- Enlarged prostate (benign prostatic hyperplasia), which can physically obstruct the rectum
- Depression and cognitive impairment, affecting awareness of the need to defecate or making it difficult to maintain healthy bowel habits
Management and Treatment
Treatment should prioritize addressing the underlying cause while incorporating lifestyle changes, such as increased fiber intake (25-30g daily), adequate hydration (at least 8 glasses of water daily), regular physical activity, and establishing consistent bathroom routines 1. Pharmacological management may include the use of over-the-counter (OTC) or prescription medications, such as polyethylene glycol (PEG), secretagogues, or prokinetic agents, as recommended by the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) 1. It is essential to consider the most recent evidence when making treatment decisions, as it provides the best guidance for managing chronic constipation in older men, with the goal of improving morbidity, mortality, and quality of life outcomes 1.
From the Research
Causes of Chronic Constipation in Old Men
- Decreased mobility and other comorbid medical conditions may contribute to the increased prevalence of constipation in older adults 2
- Functional constipation is diagnosed when no secondary causes can be identified, such as a medical condition or a medicine with a side effect profile that includes constipation 2
- Colonic sensorimotor disturbances and pelvic floor dysfunction are the most widely recognized pathogenic mechanisms of chronic constipation 3
- Medications, such as opioids, can also cause constipation 3
- Anatomic alterations, although rare, can also contribute to chronic constipation 3
Risk Factors
- Age: constipation is more prevalent in older adults 2, 3
- Comorbid medical conditions: conditions such as diabetes, Parkinson's disease, and stroke can increase the risk of constipation 2, 3
- Medications: certain medications, such as opioids, anticholinergics, and calcium channel blockers, can cause constipation 2, 3
- Decreased mobility: reduced physical activity can contribute to constipation 2, 3
- Dietary factors: a low-fiber diet can contribute to constipation 4, 5, 6
Diagnosis
- A thorough medical history and physical examination are essential for diagnosing chronic constipation 3
- Anorectal tests, such as anorectal manometry and defecography, can be used to evaluate defecatory disorders 3
- Colonic transit studies can be used to assess colonic motility 3
- A stool diary can be used to record the nature of bowel movements and identify patterns of constipation 2