What medications should elderly people take for constipation?

Constipation is a very common gastrointestinal disorder, particularly prevalent among older adults. Mild constipation typically does not significantly affect daily life and often resolves with lifestyle modifications—such as improved diet, increased physical activity, and establishment of regular bowel habits—without requiring medication or with minimal pharmacological intervention. However, severe constipation in elderly individuals poses substantial health risks and thus warrants prompt medical treatment. So, what medications are appropriate for constipation in older adults? Below is an overview.

Medications for Constipation in Older Adults

1. Lubricant Laxatives

Administered orally or via enema, these agents coat the stool surface, facilitating its passage through the intestine. They reduce intestinal water absorption and promote peristalsis. Representative agents include glycerin, liquid paraffin, peanut oil, soybean oil, sesame oil, honey, and glycerin suppositories (e.g., Dulcolax®).

2. Stimulant Laxatives

These drugs primarily stimulate intestinal motility to facilitate stool expulsion. Common examples include senna leaf, rhubarb, and aloe vera—all anthraquinone-based laxatives. Although many assume such agents are harmless, long-term or inappropriate use carries serious risks, including melanosis coli (pigmentation of the colonic mucosa).

3. Prokinetic Agents

Indicated for severe gastrointestinal motility disorders, these agents are effective for slow-transit constipation. Examples include cisapride and mosapride. These medications should be taken orally 15 minutes before meals and must not be co-administered with grapefruit juice.

4. Osmotic Laxatives

These agents exert their effect by drawing water into the intestinal lumen, thereby increasing intraluminal volume and pressure, which stimulates peristalsis. Lactulose is the most commonly used osmotic laxative in older adults due to its mild efficacy and high safety profile—it is not absorbed systemically. Another frequently used agent is polyethylene glycol 4000 powder, often employed for bowel preparation prior to colonoscopy.