ABSTRACT
Constipation is classically defined as passing stools less often than once every three days. It may alternatively be described as difficulty passing stools (dyschezia) due to their hard or pebble-like nature, or difficulty in initiating evacuation despite regular bowel motions. 1 A distinction of subtypes of constipation into either slow transit time or difficult stool expulsion has been proposed but some overlap does exist. 2 Constipation is more common in older than younger people, but its incidence and prevalence are hard to establish accurately as people's perception of constipation often differs from the clinical definition. A survey of older people found that around 30% reported constipation but only 3% actually opened their bowels less than three times per week. 3 A study of the community-dwelling elderly (aged 65-93 years) found a prevalence of chronic constipation of 24% (defined as straining at stool or less than three motions per week more than 25% of the time). 4 Changes in the bowel associated with ageing that may increase the likelihood of developing constipation include reduced neuronal function and anal sphincter fibrosis.
