Chronic constipation (CC) is a common disorder in the elderly population globally and is associated with comorbidities and negative implications on the quality of life. Constipation prevalence varies in different studies, primarily owing to the nonuniformity of the diagnostic criteria. However, 15%–30% of individuals aged >60 years are diagnosed with CC. Primary care physicians are the main healthcare providers that manage constipation in elderly patients in parallel with increased population aging and increased prevalence of constipation. Physical inactivity, polypharmacy, chronic medical conditions, rectal hyposensitivity, and defecatory disorders all play a role in the pathogenesis of CC in elderly patients. Detailed anamnesis, particularly history related to chronic medication use, with digital rectal examination may assist in identifying constipation causes. Additionally, blood tests and colonoscopy may identify organic causes of CC. Physiologic tests (i.e., anorectal manometry, colonic transit time with radiopaque markers, and defecography) can evaluate the physiologic function of the colon, rectum, and anus. However, generally, there are several causes of constipation in older patients, and an individualized approach is recommended. Treatment of chronic idiopathic constipation is empiric, based on the stepwise approach. Lifestyle advice, adjustment of chronic medications, and prescription of laxatives are the first steps of management. Several laxatives are available, and the treatment is evolving in the last decade. Biofeedback is an effective therapy especially for defecatory disorders. This review aimed to summarize the most updated knowledge for primary care physicians in the approach and management of CC in elderly patients.

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Background
Constipation is one of the most common digestive complaints. Although, there are increased interest on the socioeconomic effect of constipation and studies associated with quality of life on constipation, there is no study about the infl uence of constipation onto quality of life (QOL) in Korea. We studied the impact of functional constipation on QOL. Methods: Between March to June 2008, person to person survey with 844 elderly aged over 60 years was performed at two senior care centers, a public health center, and secondary hospital in Seoul metrocity and Chung-ju city. The diagnosis of functional constipation was based on the Rome III criteria and QOL was measured by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36). Results: The average age was 73.6 years and the prevalence rate of constipation was 20.3%. The average SF-36 score was 63.5 in total population, 57.9 in constipation group, and 64.9 in normal group. Conclusion: These results suggest that the constipation lowers QOL in adults aged over 60 years old. Further study will be necessary to explore if QOL changes according to the severity of constipation and its treatment and to assess QOL using a disease-specifi c measurement tool that can be used for Korean environment.

Citations

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Background
: Gastrointestinal (GI) symptoms are believed to be common in the general population, and constipation is one of the most representative GI symptoms. However, the prevalence and risk factors of functional constipation are not well known in Korea. We aimed to study the prevalence of, and risk factors for, constipation in the elderly.

Methods : We randomly selected 852 among 854 (excluded by cancer and dementia) subjects, ages 65 yr and older, in three different geriatric welfare facilities in December, 2003. The prevalence of functional constipation was based on the Rome II criteria and the survey on risk factors for constipation was performed.

Results : Functional constipation had a prevalence of 26.6% and there was no difference between men and women. Exercise, fluid·fruit·vegetable intake, anal diseases and age related risk factors were associated with constipation.

Conclusion : In the elderly, constipation is a common complaint. Further studies are now required for risk factors of constipation.

Background
: A habit of lying-down after eating is known as a risk factor of reflux esophagitis. However the association between gastrointestinal disorders and a postprandial lying-down habit has not yet been identified. Some people believe that lying-down after meals is helpful for their health. We intended to investigate the relationship between such a habit and the health lifestyles, gastrointestinal symptoms, disorders using a questionnaires and gastrofiberscopic results of patients who visited our general health screening center.

Methods : We examined 1,030 subjects (the frequent postprandial lying-down group was 576 persons (57.7%), the rare group was 436 persons (42.3%) who visited our general health screening center for a routine check-up including a gastrofiberoscopy during the period between January 2001 to December 2002. After frequency matching by age and sex, health lifestyles (such as smoking, alcohol consumption, exercise, eating habits, night time sleep duration and awakening frequency, nap, and coffee intake), gastrointestinal symptoms (dyspepsia, epigastric pain, heart burn, chest pain, and constipation) and gastrofiberoscopic findings were compared using results from the questionnaires and gastrofiberscopic findings. Factors such as gastritis and reflux esophagitis were set as dependent variables, while postprandial lying-down was set as an independent variable. The frequent postprandial lying-down group and the rare group were analysed through stepwised multiple logistic regression analysis.

Results : Subjects with a frequent postprandial lying- down habit showed a significantly greater degree in alcohol consumption (P=0.010), irregular eating habits (P＜0.001), eating between meals (P＜0.001), napping (P＜0.001), and night time awakening frequency (P= 0.016) than the rare group did. In addition, chest pain (P=0.031) and constipation (P=0.010) were more common in the frequent postprandial lying-down group. However, prevalence of dyspepsia (P=0.147), epigastric pain (P=0.085), and heartburn (P=0.700) showed no differences between the two groups. Being controlled with age, sex, education level, body mass index, and life style factors, postprandial lying-down group showed higher prevalence ratios in erythematous gastritis (OR 1.59; P=0.090), atrophic gastritis (OR 1.71; P= 0.059), and reflux esophagitis (OR 1.78; P=0.103).

Conclusion : A postprandial lying-down habit is associated with undesirable lifestyles and some gastrointestinal disorders. Therefore, a modification of the postprandial lying-down habit should be recommended. Further investigation is needed to clarify the causal relationships between a postprandial lying down habit and gastrointestinal symptoms and disorders.