From the Guidelines
The best treatment approach for an elderly individual with chronic constipation, hard stools, and frequent fecal impaction is a comprehensive bowel regimen that includes a combination of stool softeners, osmotic laxatives, and stimulant laxatives, along with adequate hydration, increased dietary fiber, and regular physical activity.
Key Components of the Treatment Approach
- Start with a combination of stool softeners like docusate sodium (100 mg twice daily) and osmotic laxatives such as polyethylene glycol (17 g in 8 oz water daily) 1
- For maintenance, include a stimulant laxative like senna (8.6 mg tablets, 1-2 tablets at bedtime) or bisacodyl (5-10 mg daily)
- Adequate hydration with at least 6-8 glasses of water daily and increased dietary fiber (aim for 25-30 g daily) through fruits, vegetables, and whole grains are essential components 1
- Regular physical activity within the individual's capabilities helps stimulate bowel motility
- For acute impaction, a glycerin or bisacodyl suppository may be needed, or in severe cases, manual disimpaction by a healthcare provider
Considerations for Elderly Patients
- Particular attention should be paid to the assessment of elderly cancer patients, including ensuring access to toilets, dietetic support, and managing known decrease in food intake 1
- Laxatives must be individualized and targeted to the older person’s medical history, drug interactions, and adverse effects
- Regular monitoring of chronic kidney/heart failure when a concomitant treatment with diuretics or cardiac glycosides is prescribed
Additional Treatment Options
- Peripherally acting μ-opioid receptor antagonists, such as methylnaltrexone, may help relieve opioid-induced constipation while maintaining pain management 1
- Lubiprostone and linaclotide are newer agents that have been shown to be effective in treating constipation associated with irritable bowel syndrome and chronic idiopathic constipation 1
From the FDA Drug Label
USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days PURPOSE Osmotic Laxative
The best treatment approach for an elderly individual with chronic constipation, hard stools, and frequent fecal impaction is to use polyethylene glycol (PO), an osmotic laxative 2, 2.
- It can help relieve constipation and produce a bowel movement in 1 to 3 days.
- However, it is essential to note that the treatment should be tailored to the individual's specific needs and medical history.
- Senna (PO) may also be considered, but it generally causes a bowel movement in 6 to 12 hours 3.
- It is crucial to consult a healthcare professional to determine the most suitable treatment plan.
From the Research
Treatment Approach for Elderly with Chronic Constipation
The best treatment approach for an elderly individual with chronic constipation, hard stools, and frequent fecal impaction involves a combination of lifestyle modifications and medication.
- Lifestyle modifications include scheduled toileting after meals, increased fluid intake, and increased dietary fiber intake 4.
- Additional fiber intake in the form of polycarbophil, methylcellulose, or psyllium may improve symptoms, but should be slowly increased over several weeks to decrease adverse effects 4.
- Fecal impaction should be treated with mineral oil or warm water enemas 4.
Medication Options
- Osmotic laxatives, such as polyethylene glycol (PEG) or macrogol 4000, are effective and safe treatments for constipation, even in elderly patients 5, 6.
- Stimulant laxatives, such as senna, can also be effective in improving bowel movement frequency and quality of life 7.
- Magnesium-based laxatives should be avoided due to potential toxicity, but magnesium oxide may be a suitable alternative 4, 7.
Considerations for Elderly Patients
- Bulk-forming laxatives may not be suitable for older patients due to the need to increase fluid intake 8.
- Osmotic laxatives, such as PEG, are likely to be the most suitable laxative type for older patients 8.
- Healthcare providers should proactively identify older constipated patients who are self-medicating or not receiving treatment, and increase awareness of constipation, its complications, and treatment options among patients and carers 8.