Management of

Constipation in
Adults
Stephen Aglubat, MD
May 2012

Objectives

Define Constipation
Treatment options for constipation

Case

76 year old female with PMHx of HTN, DMII, HLD,

presents to the clinic. Shes complaining of having
stools only twice a week, and feeling full. Shes
eating more vegetables, started drinking more
water, and she recently included Metamucil to her
diet. Her last colonoscopy one year ago was clean.
She comes to your office to be evaluated for her
constipation. What would you offer her for the
constipation?
A. Lactulose
B. Senna
C. Docusate
D. Weekly tap water enemas

Definition

Rome III criteria: 2 of the below

defines constipation
Straining
Lumpy Hard Stools
Incomplete Evacuation
Use of Digital Rectal Maneuvers
Sensation of Anorectal Blockage
< 3 Bowel Movements per week

Pathophysiology I

Constipation is caused by:

Primary Colorectal dysfunction

Slow Transit
Dyssnerygic Defacation
Irritable Bowel Syndrome

Pathophysiology II

Constipation is caused by:

Secondary Causes
Endocrine/Metabolic
Neurologic
Myogenic Disorders
Medications
Obstruction

Chronic Idiopathic Constipation (CIC)

Management

Initial treatment of Chronic

Functional Constipation
Lifestyle modification
Diet and fiber

Lifestyle Modifications

Increased fluid intake

Exercise
Establish regular bowel regimen
pattern

Diet and fiber

Fiber increases bulk/distension

Distention causes stool propulsion.

>25 g of fiber/day
Effect may take weeks.
Adverse effects: Bloating, flatulence

Laxatives I

Stimulant Laxatives
Senna
Bisacodyl

Laxatives II

Bulk forming laxatives

Psyllium (Metamucil)
Methylcellulose (Citrucel)
Polycarbophil (FiberCon)
Dextran (Benefiber)

Laxatives III

Osmotic Laxatives
Polyethylene glycol
Lactulose
Sorbitol
Magnesium Hydroxide

Other therapies

Colonic secretagogues

Lubipristone

Summary

Constipation in the older adult may be

due to chronic constipation, secondary
etiologic factors
A thorough history must be obtained to
rule out secondary causes.
Therapy includes:
Diet/lifestyle
Stimulant Laxatives
Osmotic Laxatives

Case

76 year old female with PMHx of HTN, DMII, HLD,

presents to the clinic. Shes complaining of having
stools only twice a week, and feeling full. Shes
eating more vegetables, started drinking more
water, and she recently included Metamucil to her
diet. Her last colonoscopy one year ago was clean.
She comes to your office to be evaluated for her
constipation. What would you offer her for the
constipation?
A. Lactulose
B. Senna
C. Docusate
D. Weekly tap water enemas

Case

76 year old female with PMHx of HTN, DMII, HLD,

presents to the clinic. Shes complaining of having
stools only twice a week, and feeling full. Shes
eating more vegetables, started drinking more
water, and she recently included Metamucil to her
diet. Her last colonoscopy one year ago was clean.
She comes to your office to be evaluated for her
constipation. What would you offer her for the
constipation?
A. Lactulose
B. Senna
C. Docusate
D. Weekly tap water enemas

References

1. Management of chronic
constipation in older adults. Wald,
Arthur. Uptodate.com. March 2012