From the Guidelines
The best initial treatment approach for constipation in elderly patients is to start with lifestyle modifications, including increasing dietary fiber intake, ensuring adequate hydration, and establishing a consistent toileting routine, as recommended by the most recent study 1. This approach is supported by the latest evidence, which emphasizes the importance of a varied and balanced diet, rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, as well as adequate hydration with at least 8 cups (64 ounces) of water per day 1. Key lifestyle modifications include:
- Increasing fibre intake through whole grains, legumes, fruits, and vegetables
- Consuming probiotic and prebiotic foods, such as yogurt, kefir, sauerkraut, kimchi, and fermented foods
- Limiting processed foods and added sugars
- Considering a multivitamin or supplement, as necessary, under the guidance of a healthcare professional If lifestyle modifications are insufficient, osmotic laxatives such as polyethylene glycol (PEG 3350,17 grams daily) can be considered as first-line pharmacological therapy, as they are generally well-tolerated and can be used safely for longer periods 1. It is essential to individualize laxative treatment, taking into account the patient's medical history, drug interactions, and potential adverse effects, and to regularly monitor for chronic kidney or heart failure, especially when concomitant treatments with diuretics or cardiac glycosides are prescribed 1. By prioritizing lifestyle modifications and using pharmacological therapy judiciously, healthcare providers can effectively manage constipation in elderly patients while minimizing potential adverse effects.
From the FDA Drug Label
Adults 12 yrs. & older 1 packet in 8 oz of liquid at the first sign of irregularity. Can be taken up to 3 times daily. Uses for relief of occasional constipation (irregularity). This product generally produces bowel movement in 12 to 72 hours.
The best initial treatment approach for constipation in elderly patients is to use psyllium (PO), starting with 1 dose per day and gradually increasing to 3 doses per day as necessary 2. This can help relieve occasional constipation and generally produce a bowel movement in 12 to 72 hours 2.
- Key points:
- Start with a low dose and increase as needed
- Mix with at least 8 ounces of water
- Can be taken up to 3 times daily
- May cause changes in bowel habits or minor bloating as the body adjusts to increased fiber intake 2
From the Research
Initial Treatment Approach
The best initial treatment approach for constipation in elderly patients typically involves lifestyle modifications, including:
- Scheduled toileting after meals
- Increased fluid intake
- Increased dietary fiber intake
- Additional fiber intake in the form of polycarbophil, methylcellulose, or psyllium 3
- Bowel training measures 4
Pharmacological Treatment
If lifestyle modifications are not effective, pharmacological treatment may be considered, including:
- Osmotic laxatives, such as polyethylene glycol 3, 5
- Stool softeners, such as docusate sodium 3
- Stimulant laxatives 3
- Linaclotide or lubiprostone for patients who do not respond to other treatments 3
Considerations for Elderly Patients
Elderly patients may require a tailored approach to treatment, taking into account their individual symptoms, medical history, and comorbid conditions 6, 4. Additionally, healthcare providers should be aware of the potential for constipation to be a symptom of an underlying condition, rather than a primary condition itself 3, 4.
Importance of Awareness and Education
Awareness and education about constipation, its complications, and treatment options are essential for healthcare providers, patients, and caregivers 5. This can help to reduce the burden of constipation on elderly patients and improve their quality of life.