Management of bowel problems in older people: an update.

Seventeen per cent of people over the age of 65 and 80% of people in care homes are constipated. Approximately 3-10% of older people in the community have faecal incontinence. Careful attention to assessment, based on an understanding of pathophysiology, will provide an explanation for bowel dysfunction. The causes are often multiple and may relate to local bowel pathology, systemic disease, complications of medication or functional disability. The possibility of underlying serious bowel disease must be borne in mind. Management should be directed to correcting the underlying causes. Laxatives, suppositories and enema use should be determined by the presence or absence of delayed transit and difficulty in evacuation. In the presence of dementia, a clear understanding of the physical and psychological disturbances present must be established to enable an effective management plan. Particular attention should be paid to the environment to promote privacy, comfort and dignity, as well as to enhance normal bowel function.