Regulation of Bowel Function by a Laxative/Stool Softener Preparation in Aged Nursing Home Patients

Abstract

A 12-week program for 42 chronically constipated patients in a nursing home involved a graduated dosage regimen of standardized senna concentrate with dioctyl sodium sulfosuccinate (Senokot-S Tablets), a high-fiber diet, and an increased fluid intake. The program achieved a satisfactory pattern of bowel evacuation in 36 (86 percent) of these patients. This pattern, as observed during a 4-week follow-up period while therapy was continued, was characterized by absence of fecal impactions, regular comfortable bowel movements of appropriate consistency, minimal or no straining at stool, and minimal or no resort to enemas. In the initial 2-week control period, none of the 42 patients had responded adequately to only dietary modification and increased hydration. Six additional patients whose response to the control regimen was equivocal, also appeared to benefit from the medication program. Two of these were able to discontinue the laxative tablets completely by the end of the 12-week test period. None of the 48 patients who completed the course experienced any adverse effects related to this rehabilitative program.

Constipation: Assessment and Management in an Institutionalized Elderly Population

“…Recent published literature 12,13 and the Physicians Desk Reference clearly describe docusate as a fecal softener without any laxative action, and there are only minimal data to support the efficacy of magnesium hydroxide as a laxative in the elderly 14 . In contrast, the effectiveness of less frequently employed agents such as senna, 15–18 bulking agents, 19–21 sorbitol, 22 and lactulose, 23,24 has been demonstrated in elderly subject groups. “Fleets” phosphate and soap sud enemas were used much more often than tap water enemas, although they are reported to have more associated side effects in the elderly 25–27 .…”

Constipation in the Elderly

“…A minimum of 1500 mL of fluid input per day is advisable to prevent dehydration and reduce the risk of constipation in the elderly, with increased intake in the summer and in patients on diuretics with stable cardiovascular status 3,20,56,89 . A program of regular exercise should be considered, within the functional limitations of each individual.…”

“…Other studies employ outcomes such as reduction in previous laxative and enema use, need for additional laxatives during the trial, number of episodes of fecal impaction, achievement of “comfortable” defecation, and nursing time spent on providing bowel care 19,96 . Finally, commercial laxative preparations with two or more agents combined are frequently the studied drug, making it difficult to distinguish the benefits of each individual laxative type 89,97,99,100 …”

“…Senna generally induces evacuation 8–12 hours after administration, but frail elderly patients have slower response times 96 and may also require up to 10 weeks of daily use before achieving regular bowel habit 89 . Bedtime administration minimizes the risk of nocturnal fecal incontinence, and the dosage should be titrated according to each individual's response 89,96 . Maintenance therapy two or three times a week may be necessary in chronically ill patients with very prolonged colonic transit time 78 .…”

A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

“…[1][2][3][4] The underlying mechanisms of FI and other problems related to stool discharge and evacuation are poorly understood, and management of these conditions remains problematic. Typically, a plethora of medications is advised, including laxatives, 5,6 laxative and stool softener preparations, 7 sorbitol, 8 lactulose, 9,10 a senna-fiber combination, 9 bulk fibers, [11][12][13][14] herbal supplements, 15 and an intestinal secretagogue, 16 but there is little evidence to support the efficacy of any of these medications. Prompted-voiding toileting interventions, which increase the frequency of toileting, are also recommended and help compensate for the risk factors of immobility and dementia common to urinary incontinence (UI) and FI.…”