Pathophysiology of constipation in the older adult

Table 1 Rome III criteria for defining functional constipation

Loose stools rarely present with laxative use and insufficient criteria for IBS and

Two or more of the following (fulfilled for the last 3 mo with symptom onset at least 6 mo prior to diagnosis):

Fewer than three bowel movements per week

Straining1

Lumpy or hard stools1

Sensation of incomplete evacuation1

Sensation of anorectal obstruction or blockade1

Manual maneuvers (e.g., digital evacuation, support of the pelvic floor)

To facilitate a bowel movement1

¹≥ 25% of defecations. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders and functional abdominal pain. Gastroenterology 2006; 130: 1486.

Table 2 Etiology of constipation in the older adult

Endocrine and metabolic disease

Diabetes mellitus

Hypothyroidism

Neurologic disease

Autonomic neuropathy

Cerebrovascular disease

Multiple sclerosis

Parkinson’s disease

Spinal cord injury

Psychological conditions

Anxiety

Depression

Structural abnormalities

Anorectal conditions: fissures, hemorrhoids, rectal prolapse or rectocele

Obstructive colonic lesions

Lifestyle

Dehydration

Low calorie diet

Low fiber diet

Immobility

Iatrogenic

Medications