From the Guidelines
For an older adult with chronic constipation who only takes a daily multivitamin and occasional ibuprofen, I would recommend adding psyllium to their daily regimen to relieve constipation. This recommendation is based on the most recent and highest quality study available, which suggests that fiber supplementation, particularly psyllium, can be used as first-line therapy for chronic idiopathic constipation (CIC) in adults 1. The study, published in 2023 in the journal Gastroenterology, found that among the evaluated fiber supplements, only psyllium appears to be effective, with very limited and uncertain data on bran and inulin.
Some key points to consider when adding psyllium to the patient's regimen include:
- Dietary assessment is important to determine total fiber intake from diet and supplements
- Adequate hydration should be encouraged with the use of fiber
- Flatulence is a commonly observed side effect with the use of fiber
- The patient should be advised to start with a low dose and gradually increase as needed and tolerated
It's also important to note that the occasional use of ibuprofen may contribute to constipation, so adequate hydration (6-8 glasses of water daily) and increased dietary fiber (aim for 25-30 grams daily) should accompany medication therapy. The patient should contact their healthcare provider if they experience severe abdominal pain, blood in stool, or if constipation persists despite these interventions.
Other options, such as osmotic laxatives (e.g., polyethylene glycol) or stimulant laxatives (e.g., senna), may be considered if psyllium is not effective or tolerated, but psyllium is the recommended first-line therapy based on the latest evidence 1.
From the FDA Drug Label
Purpose Fiber laxative Purpose Stool softener Active ingredient (in each 5 mL = 1 teaspoonful) Sennosides 8.8 mg The best option to relieve chronic constipation in an older adult is Psyllium (C), as it is a fiber laxative 2. This is a better choice than a stool softener like Docusate sodium (A) 3 or Senna (D) 4, which is a stimulant laxative. An enema (B) is not typically used as a daily treatment for constipation.
- Key considerations:
- Psyllium is a fiber laxative that can help promote regular bowel movements.
- Docusate sodium is a stool softener that may not be enough to relieve constipation.
- Senna is a stimulant laxative that can be habit-forming and is not recommended for long-term use.
- Enema is not a suitable daily treatment for constipation.
From the Research
Treatment Options for Chronic Constipation
The treatment of chronic constipation in older adults can be approached through various methods, including lifestyle modifications and medication. Given the patient's current regimen of a daily multivitamin and occasional ibuprofen for osteoarthritis, the following options can be considered:
- Psyllium (C): Psyllium is a bulk-forming laxative that can help increase stool frequency and improve symptoms of constipation 5, 6. It is recommended to increase fiber intake slowly over several weeks to decrease adverse effects 7. However, it is crucial to instruct patients to drink a sufficient amount of fluids when taking psyllium to avoid intestinal obstruction 8.
- Docusate Sodium (A): Docusate sodium is a stool softener that can be used to treat constipation. However, studies have shown that it may not be effective in relieving constipation in older adults compared to other treatments such as psyllium or sennosides 5, 9.
- Senna (D): Senna is a stimulant laxative that can increase stool frequency and improve symptoms of constipation. It can be used in combination with psyllium to enhance its effects 5, 6.
- Enema (B): Enemas can be used to treat fecal impaction, but they are not typically recommended as a first-line treatment for chronic constipation 7.
Considerations for Treatment
When selecting a treatment option, it is essential to consider the patient's individual needs and medical history. The treatment approach should be individualized, and lifestyle modifications such as increased fluid intake and dietary fiber should be recommended before initiating medication 7, 5. Additionally, the potential risks and benefits of each treatment option should be carefully evaluated, and patients should be monitored for adverse effects.