A number of new, novel strategies for managing
constipation in the elderly have emerged over the past few years.
Prucalopride is one such new agent that is highly efficacious in managing chronic
constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg.
Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of
constipation.
Neostigmine has also been successfully used for the management of recalcitrant
constipation. Most of these studies have used subcutaneous
neostigmine. Symbiotic yogurt containing components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of
constipation. Elderly patients especially those in hospices and nursing homes are often on
opioids for
pain management.
Constipation secondary to
opioid use is extremely common in nursing homes. Subcutaneous
methylnaltrexone has recently been shown to be highly effective in the management of
opioid-related
constipation, and was recently approved by the FDA. Sacral nerve stimulation is another emerging strategy. A recent analysis by Mowatt et al supports the efficacy of this technique.
Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory
constipation in children and may be very effective for elderly
constipation. Further larger studies are needed to confirm the findings noted in these studies.
Constipation is clearly a major issue in the elderly and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of
constipation in this population.