Management of Chronic Constipation in the Older Adult |
Certified
for 1 AMA PRA Category 1 Credit™
Co-Sponsored
by
the
University of Alabama
School
of Medicine
Division of Continuing Medical Education,
Division of Gerontology, Geriatrics, and
Palliative Care, and
The Center for Aging
| Release
Date: March 12, 2008 |
Expiration
Date: March 12, 2011 |
| TARGET
AUDIENCE: |
| Primary
care physicians |
| OBJECTIVES: |
| Upon
completion of this CME activity,
participants
should be able to: |
- Understand the pathophysiologic causes of chronic constipation.
- Identify risk factors for constipation in older adults.
- Recognize and diagnose constipation in the primary care setting.
- Implement evidence-based non-pharmacologic and pharmacologic treatments for chronic constipation in older adults.
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| SOURCE: |
| EDITOR
AND CONTRIBUTING AUTHORS: |
Angela
R. Curtis, PhD
Managing Editor
Assistant Professor, Geriatric Education
Manager
Alayne Markland, DO, MSc
Assistant Professor of Medicine
Patricia S. Goode, MD, MSN
Gwen McWhorter Professor of Geriatric Medicine
Medical Director, UAB Continence Program
VA GRECC Associate Director for Clinical Programs
Division
of Gerontology, Geriatrics and
Palliative Care
University of Alabama at Birmingham
Birmingham, Alabama |
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| |
| DISCLOSURE: |
The
faculty has no commercial affiliations
to disclose.
Because of the nature of preliminary
studies, some products mentioned are
unlabeled and investigational. Dosages,
indications, and methods of use of
drugs mentioned in this publication
may reflect the experience of the authors,
clinical literature, or other resources.
Therefore, please see the full prescribing
information before using any licensed
product mentioned. |
| CME
PARTICIPATION: |
| To
participate in this online course
for CME credit, please review the
objectives before beginning the program.
Complete the course and the self-assessment
test before March 12, 2011 to receive
CME credit. Your certificate will
then be available online. This process
should take approximately 1 hour. |
| ACCREDITATION: |
The
University of Alabama School of
Medicine is accredited by the Accreditation
Council for Continuing Medical
Education to provide continuing
medical education for physicians.
The
University of Alabama School of
Medicine designates this educational
activity for a maximum of 1 AMA
PRA Category 1 Credit™.
Physicians should only claim credit
commensurate with the extent of
their participation in the activity.
The
boards of nursing in many states,
including Alabama, recognize Category
1 continuing medical education
courses as acceptable activities
for the renewal of license to practice
nursing. |
| DISCLAIMER: |
| Dosages,
indications, and methods of use of
any drug referred to in this publication
may reflect the clinical experience
of the authors, clinical literature,
or other clinical resources. Therefore,
please see the full prescribing information
before using any product mentioned.
UAB is an equal opportunity/affirmative
action institution. |
| OVERVIEW: |
Constipation is a common diagnosis that may involve infrequent, difficult, or incomplete defecation. Constipation is often defined by physicians as infrequent stools, whereas patients often complain of straining or incomplete evacuation. Usually the symptoms have to be present for at least 12 weeks. Older adults disproportionately have more chronic constipation than younger adults, with an estimated prevalence of 40% among people over 65 years of age.[1] Women have 2 to 3 times more constipation than men and African-Americans may also have an increased risk of constipation.[1]
Many community dwelling older adults commonly use over-the-counter preparations, such as stimulant and bulking laxatives.[2] Many prescriptions are also written for laxatives in older adults. However, few resources guide clinicians in the best evidence-based clinical approach to treatment for chronic constipation.
|
| INTRODUCTION - PATHOPHYSIOLOGY AND CATEGORIES OF CONSTIPATION: |
Constipation can be categorized as occurring primarily or secondarily (e.g. due to a medical diagnosis or medication use).[3] The primary causes of constipation are listed in Table 1.
Table 1. Primary pathophysiologic causes of chronic constipation
| 1. Normal transit constipation |
- Most common subtype
- Transit and stool frequency are within the normal range, but patients complain of constipation, bloating, and pain*
|
| 2. Slow transit constipation |
- Increased intestinal transit time
- Reduced colonic motility
- Multiple different etiologies - gut cellular and protein level responses
|
| 3. Defecatory Dysfunction |
- More common in older adults and women
- Structural problems on anorectal manometry and defecography
- Pelvic floor dyssynergia (failure to relax or inappropriate contraction of puborectalis muscle and external anal sphincter during defecation attempts)
- Pathogenesis not well understood
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* Presence of pain increases the likelihood of a diagnosis of Irritable Bowel Syndrome with constipation (IBS-C) instead of chronic constipation.
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| CASE 1: |
A 65-year-old woman presents with constipation over the last 3 years that worsened after she started medications for her osteoporosis and low doses of narcotic pain medications for arthritis. She notes worsening in her constipation symptoms when taking her pain medication.
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