Figure 3. Management of Constipation in the Elderly Chronic Constipation
NO
• Stop constipating medications (if possible)
impaction Fecal YES
• Increase fluid intake • Increase activity or exercise • Increase fiber intake (20-30 g/day) • Timed toilet training • Consider increasing fiber intake
• Milk of magnesia • Lactulose • Sorbitol • Senna compounds • Bisacodyl • Polyethylene glycol
YES
Continue regimen
Effective NO
• Enemas and/or suppositories • Bowel regimen to prevent recurrence
• Consider manual disimpaction
(opiod-induced constipation) Methylnaltrexone*
(dyssynergic defecation) Biofeedback therapy
Linaclotide OR Lubiprostone
* Approved only for patients with advanced illness receiving palliative care. 9
