Constipation in the elderly: influence of dietary, psychological, and physiological factors

Abstract

Objective: To identify dietary, psychological, and physiological characteristics of older individuals with chronic constipation, compared with a control group of individuals without constipation, and identify correlates of colonic transit time.

Design: Cohort study.

Setting: University hospital and affiliated clinics.

Participants: Eighteen constipated and 18 control subjects who were nondemented, ambulatory, community-dwelling outpatients over the age of 60 years.

Measures: Measures included a 1-week food diary, diet questionnaire, bowel diary, the Hopkins Symptom Checklist (SCL-90R), colonic transit study, and medical history, including queries about activity, medications, medical illnesses, and bowel symptoms.

Main results: Constipated subjects reported consuming fewer meals per day compared with control subjects (P < 0.01) and a tendency to consume fewer calories (P = 0.07). There were no differences between groups on fiber or fluid intake or any of the other dietary parameters. However, slow colonic transit was significantly related to low caloric intake (P < 0.0001), higher percent of protein in the diet (P < 0.05), low fluid intake (P < 0.05), and to psychological symptoms of somatization, obsessive-compulsiveness, depression, anxiety, and the global severity index (P < 0.05). Transit times were unrelated to crude or dietary fiber intake, activity level, or age.

Conclusions: The data suggest that constipation in this older population is related to caloric intake rather than fiber consumption or other dietary qualities. Psychological distress is associated with slowed colonic transit and should be investigated further as a possible etiologic factor in constipation.