Management of Management of Constipation in Constipation in
AdultsAdultsStephen Aglubat, MDStephen Aglubat, MD
May 2012May 2012
ObjectivesObjectives
Define ConstipationDefine Constipation Treatment options for constipationTreatment options for constipation
CaseCase 76 year old female with PMHx of HTN, DMII, 76 year old female with PMHx of HTN, DMII,
HLD, presents to the clinic. She’s complaining of HLD, presents to the clinic. She’s complaining of having stools only twice a week, and feeling having stools only twice a week, and feeling “full.” She’s eating more vegetables, started “full.” She’s eating more vegetables, started drinking more water, and she recently included drinking more water, and she recently included Metamucil to her diet. Her last colonoscopy one Metamucil to her diet. Her last colonoscopy one year ago was clean. She comes to your office to year ago was clean. She comes to your office to be evaluated for her constipation. What would be evaluated for her constipation. What would you offer her for the constipation?you offer her for the constipation?
A. LactuloseA. Lactulose B. SennaB. Senna C. DocusateC. Docusate D. Weekly tap water enemasD. Weekly tap water enemas
DefinitionDefinition
Rome III criteria: 2 of the below Rome III criteria: 2 of the below defines constipationdefines constipation StrainingStraining Lumpy Hard StoolsLumpy Hard Stools Incomplete EvacuationIncomplete Evacuation Use of Digital Rectal ManeuversUse of Digital Rectal Maneuvers Sensation of Anorectal BlockageSensation of Anorectal Blockage < 3 Bowel Movements per week< 3 Bowel Movements per week
Pathophysiology IPathophysiology I
Constipation is caused by:Constipation is caused by: Primary Colorectal dysfunctionPrimary Colorectal dysfunction
Slow TransitSlow Transit Dyssnerygic DefacationDyssnerygic Defacation Irritable Bowel SyndromeIrritable Bowel Syndrome
Pathophysiology IIPathophysiology II
Constipation is caused by:Constipation is caused by: Secondary CausesSecondary Causes
Endocrine/MetabolicEndocrine/Metabolic NeurologicNeurologic Myogenic DisordersMyogenic Disorders MedicationsMedications ObstructionObstruction
Chronic Idiopathic Constipation (CIC)Chronic Idiopathic Constipation (CIC)
ManagementManagement
Initial treatment of Chronic Initial treatment of Chronic Functional ConstipationFunctional Constipation Lifestyle modificationLifestyle modification Diet and fiberDiet and fiber
Lifestyle ModificationsLifestyle Modifications
Increased fluid intakeIncreased fluid intake ExerciseExercise Establish regular bowel regimen Establish regular bowel regimen
patternpattern
Diet and fiberDiet and fiber
Fiber increases bulk/distensionFiber increases bulk/distension Distention causes stool propulsion.Distention causes stool propulsion.
>25 g of fiber/day>25 g of fiber/day Effect may take weeks.Effect may take weeks. Adverse effects: Bloating, flatulenceAdverse effects: Bloating, flatulence
Laxatives ILaxatives I
Stimulant LaxativesStimulant Laxatives SennaSenna BisacodylBisacodyl
Laxatives IILaxatives II
Bulk forming laxativesBulk forming laxatives Psyllium (Metamucil)Psyllium (Metamucil) Methylcellulose (Citrucel)Methylcellulose (Citrucel) Polycarbophil (FiberCon)Polycarbophil (FiberCon) Dextran (Benefiber)Dextran (Benefiber)
Laxatives IIILaxatives III
Osmotic LaxativesOsmotic Laxatives Polyethylene glycolPolyethylene glycol LactuloseLactulose SorbitolSorbitol Magnesium HydroxideMagnesium Hydroxide
Other therapiesOther therapies
Colonic secretagoguesColonic secretagogues LubipristoneLubipristone
SummarySummary
Constipation in the older adult may Constipation in the older adult may be due to chronic constipation, be due to chronic constipation, secondary etiologic factorssecondary etiologic factors
A thorough history must be obtained A thorough history must be obtained to rule out secondary causes.to rule out secondary causes.
Therapy includes:Therapy includes: Diet/lifestyleDiet/lifestyle Stimulant LaxativesStimulant Laxatives Osmotic LaxativesOsmotic Laxatives
CaseCase 76 year old female with PMHx of HTN, DMII, 76 year old female with PMHx of HTN, DMII,
HLD, presents to the clinic. She’s complaining of HLD, presents to the clinic. She’s complaining of having stools only twice a week, and feeling having stools only twice a week, and feeling “full.” She’s eating more vegetables, started “full.” She’s eating more vegetables, started drinking more water, and she recently included drinking more water, and she recently included Metamucil to her diet. Her last colonoscopy one Metamucil to her diet. Her last colonoscopy one year ago was clean. She comes to your office to year ago was clean. She comes to your office to be evaluated for her constipation. What would be evaluated for her constipation. What would you offer her for the constipation?you offer her for the constipation?
A. LactuloseA. Lactulose B. SennaB. Senna C. DocusateC. Docusate D. Weekly tap water enemasD. Weekly tap water enemas
CaseCase 76 year old female with PMHx of HTN, DMII, 76 year old female with PMHx of HTN, DMII,
HLD, presents to the clinic. She’s complaining of HLD, presents to the clinic. She’s complaining of having stools only twice a week, and feeling having stools only twice a week, and feeling “full.” She’s eating more vegetables, started “full.” She’s eating more vegetables, started drinking more water, and she recently included drinking more water, and she recently included Metamucil to her diet. Her last colonoscopy one Metamucil to her diet. Her last colonoscopy one year ago was clean. She comes to your office to year ago was clean. She comes to your office to be evaluated for her constipation. What would be evaluated for her constipation. What would you offer her for the constipation?you offer her for the constipation?
A. LactuloseA. Lactulose B. SennaB. Senna C. DocusateC. Docusate D. Weekly tap water enemasD. Weekly tap water enemas
ReferencesReferences
1. Management of chronic 1. Management of chronic constipation in older adults. Wald, constipation in older adults. Wald, Arthur. Uptodate.com. March 2012 Arthur. Uptodate.com. March 2012