Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 511

Of the multiple causes of constipation in older people, most relate to medication use or coexisting medical illness (Tables 20.2 and 20.3). The most commonly implicated medications are opiates, calcium channel blockers, non‐steroidal anti‐inflammatory drugs (NSAIDs), and medications with anticholinergic effects. Although immobility and reduced fluid and fibre intake are often implicated in the development of constipation, there is little evidence to support this folklore. Increased physical activity does not reliably improve constipation.³³ Reduced caloric intake correlates more closely with constipation in elders than do differences in fibre intake.²² Likewise, reduced fluid intake showed no significant association with chronic constipation. Increased psychological distress correlates with reports of constipation by elders, although the mechanism for this association remains unknown.^15,22

Table 20.2 Medications commonly associated with constipation.

Anticonvulsants: gabapentin, phenytoin, pregabalin

Antidepressants: SSRIs (selective serotonin reuptake inhibitors), TCAs (tricyclic antidepressants)

Antihistamines: hydroxyzine Anticholinergic drugs: antipsychotics, oxybutynin

Parkinson’s drugs: bromocriptine, amantadine, pramipexole, levodopa

Antihypertensives: calcium channel blockers, beta blockers, diuretics

Cation agents: antacids (calcium and aluminium), ferrous gluconate, ferrous sulphate

Analgesia: non‐steroidal anti‐inflammatory drugs, opiates

Antiemetics: ondansetron, prochlorperazine

Table 20.3 Medical conditions commonly associated with constipation.

Mechanical obstruction
Colonic neoplasia
Colonic stricture (intrinsic or extrinsic)
Anal stenosis
Metabolic
Amyloidosis
Chronic kidney disease
Diabetes mellitus
Electrolyte disturbance (hypercalcaemia, hypomagnesaemia)
Hyperparathyroidism
Hypothyroidism
Neurological
Autonomic neuropathy
Cerebrovascular accident
Dementia
Multiple sclerosis
Parkinson’s disease
Rheumatological
Polymyositis
Scleroderma
Psychiatric
Depression