Constipation in the Elderly: Investigation

The chief, and perhaps the sole, reason for contemplating invasive investigation of constipated elderly patients is the detection of treatable carcinoma of the colon or rectum. Colorectal carcinoma has a reasonably good prognosis with early treatment. Even when spread has occurred, subsequent quality of life may be substantially enhanced by treatment.

Initial Evaluation of Constipation

Constipation is a common and subjective symptom that can be related to a multitude of factors, including, dietary, psychological, cultural, anatomic, and functional aspects. In addition, constipation is still surrounded by misconceptions and taboos that hamper an objective evaluation and encourage self-medication that is not always innocuous to the patient.

Constipation in Childhood: Age-related problems

Age-related problems with bowel function can be classified as those affecting new-borns and infants, those affecting toddlers and preschoolers, and those affecting school-aged children. Fortunately, some of these problems can be prevented. Infrequent stools during the first few weeks of life in a breast-fed baby who is not gaining weight suggest inadequate milk intake.

Management of chronic constipation

Chronic constipation is important to treat in childhood because obstructive constipation in the young child will interfere with the child’s physical development and overflow faecal soiling in the older child will have a destructive effect on self esteem and confidence. Constipation may also complicate other childhood illness especially urological and neurodevelopmental problems. Evolution and interaction of factors in chronic constipation in childhood.

Constipation: Complication in Cancer Patients Receiving Narcotics

Four days after discharge from the hospital, a patient with a recent diagnosis of advanced lung cancer arrived in the emergency department of a Montreal hospital with abdominal pain, nausea and vomiting, and urinary retention. His large bowel was grossly distended with stool, and he required numerous enemas and manual disimpactions to dislodge the large quantities of hard feces. The patient presented a classic example of constipation resulting from narcotic analgesic administration, without any concomitant laxative program.

Etiology of Acquired Colorectal Disease: Constipation

Functional constipation is defined by the Rome II Coordinated Committees as a group of functional disorders that present with resistant, difficult, infrequent, or seemingly incomplete defecation. Previous definitions have included a regular occurrence (in more than 25% of defecations) of excessive straining, lumpy or hard stools, a sense of incomplete evacuation, a sensation of anorectal obstruction or blockage, or less than three bowel movements per week over at least 12 consecutive weeks in the preceding 2 years. Such disorders may be congenital, as in Hirschsprung’s disease, or acquired later in life as a result of lifestyle or behavior, infection, or because of anatomic or physiologic abnormalities (Figure: Algorithm describing etiologies of various acquired constipation).