Constipation in elderly
Constipation in the elderly
Constipation is very common in the elderly. The two main pathophysiological mechanisms are slow colonic transit and disordered defaecation. Common causes of chronic constipation in elderly are: Low-fibre diet Idiopathic slow transit (colon function decreases in elderly) Anatomical dysfunction and sphincter dysfunction such as rectocele and pelvic floor descent Decreased mobility Decreased fluid intake
(to decrease the number of visits to the toilet) Cognitive problems (in case of dementia: no reaction to defaecation reflex) Too much time spent in bed (no gravity, no pressure on the GI tract) Drugs (see next topic drug-induced constipation) Parkinson's disease (characterized by slow transit and impaired relaxation of the anal sphincter) Other CNS problems: dysautonomias and spinal cord injury
A 92-year-old patient who is taking digoxin, theophylline, and salbutamol is constipated. What is the most likely cause of the constipation?
Extra info: Digoxin and theophylline are associated with diarrhoea; salbutamol has no GI effects. Hence, this patient’s water intake is the most likely cause. This is common among elderly patients.