This document discusses the management of constipation in adults. Constipation is defined using Rome III criteria as having two of the following: straining, lumpy hard stools, incomplete evacuation, use of digital maneuvers, or less than three bowel movements per week. Therapy includes lifestyle modifications like increased fluid/fiber intake and exercise, as well as laxatives such as stimulants, osmotics, and bulk formers. For the case presented, an appropriate treatment would be the osmotic laxative lactulose.

1. Management ofManagement of
Constipation in AdultsConstipation in Adults
By- Dr. Armaan SinghBy- Dr. Armaan Singh

2. ObjectivesObjectives
 Define ConstipationDefine Constipation
 Treatment options for constipationTreatment options for constipation

3. CaseCase
 76 year old female with PMHx of HTN, DMII, HLD, presents76 year old female with PMHx of HTN, DMII, HLD, presents
to the clinic. She’s complaining of having stools only twice ato the clinic. She’s complaining of having stools only twice a
week, and feeling “full.” She’s eating more vegetables, startedweek, and feeling “full.” She’s eating more vegetables, started
drinking more water, and she recently included Metamucil to herdrinking more water, and she recently included Metamucil to her
diet. Her last colonoscopy one year ago was clean. She comes todiet. Her last colonoscopy one year ago was clean. She comes to
your office to be evaluated for her constipation. What would youyour office to be evaluated for her constipation. What would you
offer her for the constipation?offer her for the constipation?
 A. LactuloseA. Lactulose
 B. SennaB. Senna
 C. DocusateC. Docusate
 D. Weekly tap water enemasD. Weekly tap water enemas

4. DefinitionDefinition
 Rome III criteria: 2 of the below definesRome III criteria: 2 of the below defines
constipationconstipation
 StrainingStraining
 Lumpy Hard StoolsLumpy Hard Stools
 Incomplete EvacuationIncomplete Evacuation
 Use of Digital Rectal ManeuversUse of Digital Rectal Maneuvers
 Sensation of Anorectal BlockageSensation of Anorectal Blockage
 < 3 Bowel Movements per week< 3 Bowel Movements per week

5. Pathophysiology IPathophysiology I
 Constipation is caused by:Constipation is caused by:
 Primary Colorectal dysfunctionPrimary Colorectal dysfunction
 Slow TransitSlow Transit
 Dyssnerygic DefacationDyssnerygic Defacation
 Irritable Bowel SyndromeIrritable Bowel Syndrome

6. Pathophysiology IIPathophysiology II
 Constipation is caused by:Constipation is caused by:
 Secondary CausesSecondary Causes
 Endocrine/MetabolicEndocrine/Metabolic
 NeurologicNeurologic
 Myogenic DisordersMyogenic Disorders
 MedicationsMedications
 ObstructionObstruction
 Chronic Idiopathic Constipation (CIC)Chronic Idiopathic Constipation (CIC)

8. ManagementManagement
 Initial treatment of Chronic FunctionalInitial treatment of Chronic Functional
ConstipationConstipation
 Lifestyle modificationLifestyle modification
 Diet and fiberDiet and fiber

9. Lifestyle ModificationsLifestyle Modifications
 Increased fluid intakeIncreased fluid intake
 ExerciseExercise
 Establish regular bowel regimen patternEstablish regular bowel regimen pattern

10. Diet and fiberDiet and fiber
 Fiber increases bulk/distensionFiber increases bulk/distension
 Distention causes stool propulsion.Distention causes stool propulsion.
 >25 g of fiber/day>25 g of fiber/day
 Effect may take weeks.Effect may take weeks.
 Adverse effects: Bloating, flatulenceAdverse effects: Bloating, flatulence

11. Laxatives ILaxatives I
 Stimulant LaxativesStimulant Laxatives
 SennaSenna
 BisacodylBisacodyl

12. Laxatives IILaxatives II
 Bulk forming laxativesBulk forming laxatives
 Psyllium (Metamucil)Psyllium (Metamucil)
 Methylcellulose (Citrucel)Methylcellulose (Citrucel)
 Polycarbophil (FiberCon)Polycarbophil (FiberCon)
 Dextran (Benefiber)Dextran (Benefiber)

13. Laxatives IIILaxatives III
 Osmotic LaxativesOsmotic Laxatives
 Polyethylene glycolPolyethylene glycol
 LactuloseLactulose
 SorbitolSorbitol
 Magnesium HydroxideMagnesium Hydroxide

14. Other therapiesOther therapies
 Colonic secretagoguesColonic secretagogues
 LubipristoneLubipristone

16. SummarySummary
 Constipation in the older adult may be due toConstipation in the older adult may be due to
chronic constipation, secondary etiologic factorschronic constipation, secondary etiologic factors
 A thorough history must be obtained to rule outA thorough history must be obtained to rule out
secondary causes.secondary causes.
 Therapy includes:Therapy includes:
 Diet/lifestyleDiet/lifestyle
 Stimulant LaxativesStimulant Laxatives
 Osmotic LaxativesOsmotic Laxatives

17. CaseCase
 76 year old female with PMHx of HTN, DMII, HLD, presents76 year old female with PMHx of HTN, DMII, HLD, presents
to the clinic. She’s complaining of having stools only twice ato the clinic. She’s complaining of having stools only twice a
week, and feeling “full.” She’s eating more vegetables, startedweek, and feeling “full.” She’s eating more vegetables, started
drinking more water, and she recently included Metamucil to herdrinking more water, and she recently included Metamucil to her
diet. Her last colonoscopy one year ago was clean. She comes todiet. Her last colonoscopy one year ago was clean. She comes to
your office to be evaluated for her constipation. What would youyour office to be evaluated for her constipation. What would you
offer her for the constipation?offer her for the constipation?
 A. LactuloseA. Lactulose
 B. SennaB. Senna
 C. DocusateC. Docusate
 D. Weekly tap water enemasD. Weekly tap water enemas

18. CaseCase
 76 year old female with PMHx of HTN, DMII, HLD, presents76 year old female with PMHx of HTN, DMII, HLD, presents
to the clinic. She’s complaining of having stools only twice ato the clinic. She’s complaining of having stools only twice a
week, and feeling “full.” She’s eating more vegetables, startedweek, and feeling “full.” She’s eating more vegetables, started
drinking more water, and she recently included Metamucil to herdrinking more water, and she recently included Metamucil to her
diet. Her last colonoscopy one year ago was clean. She comes todiet. Her last colonoscopy one year ago was clean. She comes to
your office to be evaluated for her constipation. What would youyour office to be evaluated for her constipation. What would you
offer her for the constipation?offer her for the constipation?
 A. LactuloseA. Lactulose
 B. SennaB. Senna
 C. DocusateC. Docusate
 D. Weekly tap water enemasD. Weekly tap water enemas