management of constipation in elderly

For elderly patients experiencing constipation, a proactive approach to bowel management is recommended. This includes identifying and addressing factors contributing to constipation, especially in those with limited mobility or cognitive impairments. Initial management may involve lifestyle modifications such as ensuring adequate fluid and fibre intake, alongside behavioural interventions like scheduled toileting. If these measures are insufficient, laxatives should be considered. For faecal loading contributing to incontinence, rectal administration of treatment is often the first step to clear the bowel. If this is not suitable or effective, a potent oral laxative can be used, with the patient informed about potential side effects like griping pain and loose stools. For ongoing management of chronic faecal loading, a combination of oral or rectal laxatives may be necessary to promote regular bowel emptying. For patients with limited mobility who experience faecal incontinence, a regimen to produce planned bowel actions should be offered, potentially combining oral or rectal laxatives and constipating agents. This should also consider toilet access and appropriate continence products. For specialist consideration:

• If initial management fails, or if there are concerns about bowel obstruction, specialist assessment may be required.
• For individuals with neurological or spinal disease, or those with severe cognitive impairment, tailored management strategies are essential.
• In cases of persistent faecal incontinence despite conservative measures, referral for specialist assessment, which may include anorectal physiology studies or imaging, should be considered.