Constipation and Fecal Incontinence in the Elderly
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NEUROGASTROENTEROLOGY AND MOTILITY DISORDERS OF THE GASTROINTESTINAL TRACT (SATISH RAO, SECTION EDITOR)
Constipation and Fecal Incontinence in the Elderly Brototo Deb 1 & David O. Prichard 1 & Adil E. Bharucha 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review the epidemiology, pathogenesis, clinical features, and management of primary constipation and fecal incontinence in the elderly. Recent Findings Among elderly people, 6.5%, 1.7%, and 1.1% have functional constipation, constipation-predominant IBS, and opioid-induced constipation. In elderly people, the number of colonic enteric neurons and smooth muscle functions is preserved; decreased cholinergic function with unopposed nitrergic relaxation may explain colonic motor dysfunction. Less physical activity or dietary fiber intake and postmenopausal hormonal therapy are risk factors for fecal incontinence in elderly people. Two thirds of patients with fecal incontinence respond to biofeedback therapy. Used in combination, loperamide and biofeedback therapy are more effective than placebo, education, and biofeedback therapy. Vaginal or anal insert devices are another option. Summary In the elderly, constipation and fecal incontinence are common and often distressing symptoms that can often be managed by addressing bowel disturbances. Selected diagnostic tests, prescription medications, and, infrequently, surgical options should be considered when necessary. Keywords Defecatory disorder . Nursing home . Bowel leakage . Constipation . Elderly . Fecal incontinence
Introduction Constipation and fecal incontinence (FI) are common symptoms that may coexist and affect the quality of life in elderly people. This article reviews the burden, pathogenesis, and management of these symptoms with an emphasis on the elderly.
Constipation Epidemiology Constipation may be defined by self-report, symptom criteria, or based on laxative use. The Rome criteria categorize This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract * Adil E. Bharucha [email protected] 1
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA
constipated patients into four syndromes (i.e., functional constipation, constipation-predominant irritable bowel syndrome, defecatory disorders (DDs), and opioid-induced constipation (OIC) [1, 2]. Functional constipation (FC) and constipationpredominant IBS (IBS-C) are symptom-based diagnoses. DDs are defined by symptoms of FC or IBS-C and anorectal tests indicating impaired rectal evacuation. OIC is defined by worsening symptoms of constipation when initiating, changing, or increasing opioid therapy in patients who satisfy criteria for FC. Among adults, the mean prevalence is approximately 14% with a range of 2–35% [3, 4]. In some but not all studies, chronic constipation was slightly more common in older people [4]. An internet-based survey from the USA, Canada, and the UK observed that co
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