Overall and Regional Colonic Transit Abnormalities in Elderly Patients with Constipation

Objective: Chronic constipation (CC) more frequently affects the elderly; pelvic floor dysfunction (PFD) may confuse the appraisal of the pathophysiology of CC. The aim was to characterize colonic transit (CT) in elderly with CC with/without PFD.

Design: We conducted retrospective medical records review of 191 patients ≥ 65 years who underwent scintigraphic CT for assessing CC. Overall CT and distribution of isotopes in 4 colonic regions and stool were compared with 179 healthy controls < 65 years and 183 CC < 66 years. Presence of PFD, comorbidities, and concomitant medications were documented. Data shown are median (IQR).

Results: Elderly CC patients were predominantly female (69.3%), aged 70 (67,74) years, with PFD in 56.9%. Elderly CC had overall slower CT (geometric center) at 48 h [2.5 (2.0,3.48)] compared to controls [3.79 (2.69,4.69)], but overall and proximal CT were not different compared to CC < 66 years. Combined ascending and transverse colon (AC + TC) at 48 h was lower in elderly CC [51.1 (14.4,76.5)] % compared to healthy controls [86.5 (53.6, 100)% p < 0.001]. There was no difference in overall CT among elderly CC with and without PFD. Among groups with PFD, the elderly CC (compared to CC < 66y) had higher AC + TC emptying at 24 h (8.6% [IQR 0.0-30.2] vs 0.3% [0.0-20.6] p = 0.042), but not at 48 h.

Conclusion: Overall and proximal CT of elderly with CC was slower to healthy controls, but similar to adults < 66 years with CC. In the 56.9% elderly CC with PFD, overall CT and AC + TC emptying were similar to those without PFD.