What medication can I give to an 80-year-old patient with constipation (not having a bowel movement) for 6 days?

Treatment for Constipation in an 80-Year-Old Patient

For an 80-year-old patient who has not had a bowel movement for 6 days, I recommend starting with polyethylene glycol (1 capful in 8 oz water twice daily) combined with a stimulant laxative such as senna (2-3 tablets twice daily). 1

Initial Assessment and Management

Before initiating treatment, perform a quick assessment to:

• Rule out impaction, especially if there is overflow diarrhea 1
• Rule out bowel obstruction through physical examination and consider abdominal x-ray if symptoms suggest it 1
• Check for other potential causes such as hypercalcemia, hypokalemia, hypothyroidism, diabetes mellitus, or medications 1
• Review and discontinue any non-essential constipating medications 1

First-Line Medication Options

• Stimulant laxative: Senna 2-3 tablets twice daily with goal of one non-forced bowel movement every 1-2 days 1, 2
• Osmotic laxative: Polyethylene glycol (1 capful in 8 oz water twice daily) 1, 3

If Initial Treatment Is Ineffective (within 24-48 hours)

• Add a suppository: Bisacodyl suppository (one rectally daily to twice daily) 1
• Consider adding: Lactulose 30-60 mL 2-4 times daily or magnesium citrate 8 oz daily 1
• For severe cases: Administer glycerin suppository followed by mineral oil retention enema 1
• If impaction is suspected: Perform manual disimpaction after pre-medication with analgesic and anxiolytic 1

Important Considerations for Elderly Patients

• Fluid intake: Ensure adequate hydration (at least 6-8 glasses of water daily) 1
• Physical activity: Encourage appropriate exercise if possible 1
• Dietary fiber: Consider increasing dietary fiber only if fluid intake is adequate 1

Evidence-Based Insights

• Stimulant laxatives like senna have been shown to be more effective than stool softeners alone in managing constipation 4
• A study comparing senna alone versus senna plus docusate found that adding docusate did not improve outcomes, suggesting that stool softeners may not provide additional benefit 1, 4
• For elderly patients, osmotic laxatives like polyethylene glycol are generally well-tolerated and effective 5

Common Pitfalls to Avoid

• Don't rely solely on stool softeners: Docusate sodium alone is often ineffective for established constipation 4
• Don't delay treatment: After 6 days without a bowel movement, more aggressive intervention is warranted to prevent impaction 1
• Don't ignore fluid intake: Laxatives may be ineffective without adequate hydration 1
• Don't use bulk-forming agents alone: Products like Metamucil are unlikely to control severe constipation in elderly patients without adequate fluid intake 1

Follow-up and Monitoring

• Reassess for effectiveness within 24-48 hours 1
• If no bowel movement occurs within 48 hours of initial treatment, escalate to more aggressive options 1
• For persistent constipation, consider tap water enema until clear 1
• Monitor for signs of dehydration, especially when using osmotic laxatives 6