What type of suppository is recommended for an elderly patient with constipation?

Suppository Recommendations for Elderly Patients with Constipation

For elderly patients with constipation, glycerin suppositories are the preferred first-line suppository option, while isotonic saline enemas are recommended when stronger rectal measures are needed. 1, 2

Assessment and Initial Considerations

• Evaluate for swallowing difficulties or repeated fecal impaction, which are specific indications for rectal measures in the elderly 1
• Screen for contraindications before administering suppositories:
  • Recent colorectal surgery
  • Anal or rectal trauma
  • Severe colitis or abdominal inflammation
  • Undiagnosed abdominal pain

Recommended Suppository Types for Elderly

First-Line Options:

1. Glycerin suppositories

   • Act as a gentle rectal stimulant
   • Lower risk of electrolyte disturbances
   • Suitable for most elderly patients 2

2. Bisacodyl suppositories

   • For adults: 1 suppository in a single daily dose
   • Insert well into rectum, pointed end first
   • Retain for 15-20 minutes 3

Second-Line Options (for more severe constipation):

• Isotonic saline enemas are preferable to sodium phosphate enemas due to fewer adverse effects in older adults 1

Administration Technique

• Insert suppository well into the rectum
• For bisacodyl suppositories, retain for approximately 15-20 minutes 3
• Ensure patient has access to toileting facilities, especially important for those with decreased mobility 1

Important Precautions

• Avoid sodium phosphate enemas in elderly patients due to risk of electrolyte disturbances 1, 2
• Avoid liquid paraffin for bed-bound patients and those with swallowing disorders (risk of aspiration lipoid pneumonia) 1
• Use saline laxatives (e.g., magnesium hydroxide) with caution due to risk of hypermagnesemia 1
• Avoid bulk-forming agents in non-ambulatory patients with low fluid intake due to risk of mechanical obstruction 1

Complementary Management Strategies

• Polyethylene glycol (PEG) 17g/day offers an efficacious and tolerable oral solution with good safety profile for elderly patients 1, 2
• Ensure adequate fluid intake (at least 2.0 L daily unless contraindicated) 2
• Optimize toileting schedule: educate patients to attempt defecation at least twice daily, usually 30 minutes after meals 1
• Provide dietetic support to address decreased food intake common in elderly patients 1

Monitoring

• Regular monitoring is essential, particularly in patients with chronic kidney/heart failure or those on diuretics or cardiac glycosides 1
• Watch for signs of dehydration and electrolyte imbalances
• Adjust treatment based on response and tolerability

By following these recommendations, you can effectively manage constipation in elderly patients while minimizing risks associated with suppository use.