GI PROBLEMS IN THE GERIATRIC PATIENT
Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence

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Abstract

Functional bowel disorders, including constipation, fecal impaction, and fecal incontinence, are common gastrointestinal diseases in the elderly and a major source of morbidity. Often the etiology is multifactorial. Evaluation should investigate presenting symptoms and important historical clues. An appropriate workup, including radiological studies, endoscopy, and physiological testing should be individualized. Therapy should be directed against relieving the major complaint and treating the underlying pathophysiological mechanism.

Introduction

Functional bowel disorders frequently impair the quality of life in the elderly (1). The incidence of these disorders rises dramatically starting in the seventh decade of life, and may occur alone or in combination. Despite thorough evaluation, it may be impossible to find a single etiology. Therefore, an evaluation should be tailored to the patient’s functional status and severity of symptoms. Empiric therapy, in many cases, may become necessary.

Section snippets

Constipation

Constipation is common in the Western world, and its incidence rises in the elderly in both Europe and the United States 2, 3, 4, 5. There are, on average, 2.5 million physician visits per year for constipation, especially in those age >65 yr, women, and nonwhites (3). The incidence increases in those patients on acute geriatric wards to 41% and >80% in patients in nursing homes and extended care facilities (6). Because of its high prevalence in the elderly, constipation can have significant

Fecal impaction

A potential complication of chronic constipation in the elderly is fecal impaction. Most of the same causes that produce constipation can also lead to impaction. In this case, hardened feces, usually in the distal large bowel, gives rise to lower abdominal pain, distention, obstruction, a distended and high compliant rectum, stercoral ulceration, and incontinence. Hardened stool may also be proximal than the rectosigmoid colon, in which case no fecal mass is detectable by digital rectal exam.

Fecal incontinence

Fecal incontinence is the accidental and unintentional loss of stool. Like constipation, fecal incontinence is a symptom commonly found in the elderly, estimated at 1%, and is also even more prevalent in institutionalized individuals, about 10% in nursing home patients and 30% in hospitalized individuals 44, 45. The true incidence in the general population is unknown and perhaps higher than these figures, as patients often do not admit to having these symptoms because of social embarrassment.

Conclusion

Constipation, fecal impaction, and fecal incontinence often occur in geriatric patients. A careful evaluation may detect the etiology; frequently, the cause is idiopathic. Because the quality of life is affected in many elderly patients from these diseases, therapy is encouraged to relieve symptoms and to prevent complications.

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