Management of Constipation in Family
Medicine
Meera Kaur, PhD, RD, CDE
Assistant Professor, Family Medicine
University of Manitoba, Canada
http://home.cc.umanitoba.ca/~kaur/
Case

76 year old female with PMHx of HTN & DM-2,
presents to the clinic. She’s complaining of
having stools only twice a week, and feeling
“full.” She’s eating more vegetables, started
drinking more water, and she recently included
Metamucil to her diet. Her last colonoscopy one
year ago was clean. She comes to your office to
be evaluated for her constipation. What would
you offer her for the constipation?
- A. Lactulose
- B. Senna
- C. Docusate
- D. Weekly tap water enemas
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What is constipation?
• Is a symptom, not a disease
• Is a condition in which a person has fewer than
three bowel movements a week or has bowel
movements with stools that are hard, dry, and
small, making them painful or difficult to pass
• Has varied meanings for different individuals,
patients and care givers
It is best when the stools are soft and passed at an hour
customary to the patients when in health
 Hippocrates
2
Patients definition & concept about
constipation
• Patients’ Definition
– Straining 52%, hard stools 44%, infrequent
stool 32%
• Misconception
– 62% believe that daily defecation is necessary to
good digestive health
Ala, 2006
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Rome III Criteria
• Rome III criteria: 2 of the below defines
constipation
– Straining
– Lumpy Hard Stools
– Incomplete Evacuation
– Use of Digital Rectal Maneuvers
– Sensation of Anorectal Blockage
– < 3 Bowel Movements per week
4
Diagnosis
• Good history is enough for most cases
– Duration, frequency, Consistency, blood in the stool,
weight loss, Diet, Exercise, Toilet habits, Laxative
use (what), other drugs
• Basic laboratory test
– CBC, Electrolytes, BS, BUN, Cr, TSH
• Structural
– Barium enema
– Sigmoidoscopy
– Colonoscopy
5
Causes
• Primary cause
– Primary Colorectal dysfunction
– Slow Transit
– Dyssnerygic Defecation
– Irritable Bowel Syndrome
• Secondary cause
– Endocrine/Metabolic
– Neurologic
– Myogenic Disorders
– Medications
– Obstruction
• Chronic Idiopathic Constipation (CIC)
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Management…
• Initial Management of chronic functional
constipation
– Lifestyle changes
• Exercise
• Establishing regular bowel regimen pattern
• Early rising from bed
– Diet
• High fibre (20-35 g/day including both soluble and
insoluble components)
• ↑ Fluid intake
• ↓ soft drinks, caffeinated drink
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Management…Medication…
• Bulk forming agent
– Metamucil
– Citrucel
– Konsyl
– Serutan
• Osmotic agent
– Milk of Magnesia
–
–
–
–
Fleet Phospho-Soda
Sorbitol
Cephulac
Miralax
8
Management…Medication…
• Stool Softener
– Colace
– Docusate
– Surfak
• Lubricants
– Fleet
– Zymenol
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Management…Medication…
• Stimulant
– Correctol
– Dulcolax
– Purge
– Senokot
• Chloride Channel Blockers
– Lubiprostone (Amitiza)
10
Management
• Surgery
• Biofeedback
• Alternative and Complementary Medicine
– Yoga
– Warm water + Honey
– Herbal preparation
– Homeopathic and Ayurvedic treatment
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Complication
• Hemorrhoid
• Anal Fissures
• Rectal Prolapse
• Fecal Impaction
12
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References
• Books
• Journal articles published during 1990-2012
• International, National and Provincial governments’
•
•
•
relevant websites
Regulatory organizations’ websites and reports
Other relevant organizations’ publications/reports
Guidelines, and
References are available on request
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Thank you
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Summary



Constipation in the older adult may be due to
chronic constipation, secondary etiologic
factors
A thorough history must be obtained to rule
out secondary causes.
Therapy includes:
Diet/lifestyle
 Stimulant Laxatives
 Osmotic Laxatives
 Bulk Forming agents
 Other therapy

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Questions?
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