Pathophysiology of constipation in the older adult

Abstract

This review provides information on the definition of constipation, normal continence and defecation and a description of the pathophysiologic mechanisms of constipation. In addition, changes in the anatomy and physiology of the lower gastrointestinal tract associated with aging that may contribute to constipation are described. MEDLINE (1966-2007) and CINAHL (1980-2007) were searched. The following MeSH terms were used: constipation/etiology OR constipation/physiology OR constipation/physiopathology) AND (age factors OR aged OR older OR 80 and over OR middle age). Constipation is not well defined in the literature. While self-reported constipation increases with age, findings from a limited number of clinical studies that utilized objective measures do not support this association. Dysmotility and pelvic floor dysfunction are important mechanisms associated with constipation. Changes in GI function associated with aging appear to be relatively subtle based on a limited amount of conflicting data. Additional research is warranted on the effects of aging on GI function, as well as on the timing of these changes.

Figure 1

Manometric and electromyographic recordings seen with normal (A) and abnormal (B) defecation. EMG: Electromyography; Footnote: Wald A. Manometry. In: Schuster MM, Crowel MD, Koch KL, eds. Atlas of Gastrointestinal Motility in Health and Disease 2nd ed, Hamilton, and Ontario: BC Decker; 2002: 289-303.