Constipation

Constipation is a very common presenting symptom in elderly people. There are two reasons for this: (1) bowel function and defecation become less satisfactory with advancing years, since emptying may be incomplete and the presence of a small residue of feces may cause continuing discomfort; and (2) uncertainty as to what constitutes a normal bowel pattern may create anxieties about disease or other aspects of aging. Physicians often find that if they ask an elderly patient if he or she suffers from constipation, the answer will be "yes," even if the number of motions a week is within the normal range.

By constipation, patients may mean one of several things:

• • bowel motions are less frequent than they used to be
• • bowel motions are less frequent than they think that they ought to be
• Figure 1 Diagram of the colon. a. Cecum—junction between small and large bowel, also the appendix. b. Ascending colon. c. Transverse colon. d. Descending colon. e. Sigmoid colon. f. Rectum. g. Anus. SOURCE: Author
  • bowel motions are hard and more difficult to pass

The first of these is important and requires some investigation. The second is problematical, since the normal range of frequency of defecation varies between three times daily and twice weekly. In general, this does not change with aging, though it may increase. The third is an effect of constipation itself.