Constipation and Fecal Incontinence in the Elderly

To describe the epidemiology, classification, pathogenesis, clinical features, diagnostic modalities, and treatment options for primary constipation and fecal incontinence (FI) in older adults.

Both constipation and FI are classified using the Rome IV criteria and require exclusion of secondary causes before a primary diagnosis can be made. Initial evaluation should include a thorough clinical history, review of medications, triaging need for colonoscopy, and a digital rectal examination. When initial evaluation of constipation is unrevealing, conservative management with dietary modification and laxative therapy should be pursued. If these measures are unsuccessful, then further testing is indicated, which may include anorectal manometry or imaging. Defecation disorders benefit from biofeedback in addition to laxative therapy. When FI is suspected on initial evaluation, anorectal manometry should be performed with additional studies dependent on the clinical scenario. Treatment of FI is multimodal and may include bowel training, dietary modification, anti-diarrheal agents, biofeedback therapy, and sacral nerve stimulation, among other interventions.

Constipation and fecal incontinence are common conditions in the elderly that have significant impact on quality of life. Both conditions require exclusion of secondary causes and a multi-modal approach to diagnostics and management.