The incidence of chronic constipation increases with age, but its causes remain unknown, and recommendations for treatment vary widely. Now a review of 16 randomized controlled trials separates the treatments backed by scientific evidence from those that are not.
Researchers writing online last week in The Canadian Medical Association Journal reviewed studies of dietary fibers, laxatives, enemas and suppositories, stimulants and stool softeners, drinking water and exercising. The people in the trials were age 65 on average.
The scientists found that lactulose and polyethylene glycol, laxatives sold under various brand names, had statistically significant effects in several trials. One small study found stool softeners helpful, and a study of senna, an herbal stimulant, also showed benefit. The evidence for dietary fiber was lacking or inconsistent, and there was little or no evidence that enemas, suppositories, physical activity or increased fluid intake had any beneficial effect on chronic constipation.
The lead author, Dr. Dov Gandell, a geriatrician at the University of Toronto, said that the best clinical trial evidence is for lactulose and polyethylene glycol, but that other remedies may work.
"It depends on the patient," he said. "An ambulatory, non-frail elder may do well with increasing fiber content. If it's a frail elder, the risk of increased fiber would outweigh the benefits, and I would go with lactulose or polyethylene glycol, based on the evidence."
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