geriatrРоссийский журнал гериатрической медициныRussian Journal of Geriatric Medicine2686-86362686-8709Сайт издателя10.37586/2686-8636-4-2023-289-294geriatr-373Research ArticleОБЗОРЫREVIEWSСлабительные препараты в гериатрической практике: от предоперационной подготовки кишечника до коррекции хронического запораLaxatives in Geriatric Practice: From Preoperative Bowel Preparation to Correction of Chronic Constipationhttps://orcid.org/0000-0003-1222-3351ОстапенкоВ. С.OstapenkoV. S.

Остапенко Валентина Сергеевна, канд. мед. наук, врач-гериатр, заведующая отделением гериатрической терапии, доцент кафедры болезней старения

Москва

Ostapenko Valentina S., MD, PhD, Head of  Geriatrics Department, Associate Professor, Age-Related Diseases Department

Moscow

ostapenkovalent@yandex.ruФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России, Российский геронтологический научно-клинический центрРоссияPirogov Russian National Research Medical University, Russian Gerontological Research and Clinical CenterRussian Federation202317012024164№4(16) 2023289294Copyright © Остапенко В.С., 20242024Остапенко В.С.Ostapenko V.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.geriatr-news.com/jour/article/view/373

В  первой части статьи рассмотрены вопросы предоперационной подготовки кишечника у  пациентов пожилого и старческого возраста с акцентом на наиболее безопасные препараты. Во второй части статьи разобрана проблема хронического запора как гериатрического синдрома, в том числе с описанием возраст-ассоциированных изменений строения и функции толстого кишечника, причин развития запоров и особенностей коррекции в гериатрической практике.

The first part of  the article discusses the issues of  preoperative bowel preparation in  older and oldest-old patients, with a  particular emphasis on  the safest drugs. The second part of  the article presents the problem of  chronic constipation as a geriatric syndrome, including a description of age-associated changes in the structure and function of colon, causes of constipation and features of correction in geriatric practice.

предоперационная подготовка кишечникахронический запоргериатрический синдромстарческая астенияслабительные препаратыклетчаткапсиллиумосмотические слабительныеполиэтиленгликольстимулирующие слабительныеколоноскопияpreoperative bowel preparationchronic constipationgeriatric syndromefrailtylaxativesfiberpsylliumosmotic laxativespolyethylene glycolstimulant laxativescolonoscopyReferencesLeaper D.J., and Edmiston C.E. “World Health Organization: global guidelines for the prevention of surgical site infection” Journal of Hospital Infection. 2017; 95 (2): 135–136Leaper D. J., and EdmistonC. E. “World Health Organization: global guidelines for the prevention of surgical site infection,” Journal of Hospital Infection. 2017; 95 (2): 135-136.Migaly J., Bafford A.C., Francone T.D. et al. The American society of colon and rectal surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. Diseases of the Colon & Rectum. 2019; 62 (1): 3–8MigalyJ., BaffordA. C., FranconeT. D. et al. The American society of colon and rectal surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. Diseases of the Colon & Rectum.2019; 62 (1): 3–8.Diakosavvas M., Thomakos N., Psarris A. et al. Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery. ScientificWorldJournal. 2020; 14Diakosavvas M, Thomakos N, Psarris A. et al. Preoperative Bowel Preparation in Minimally Invasive and Vaginal Gynecologic Surgery. ScientificWorldJournal. 2020; 14.By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052–2081By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.Журавлева М.В. и соавт. Клиническая фармакология препаратов для подготовки к диагностическим исследованиям и оперативным вмешательствам, требующим очищения кишечника: анализ параметров эффективности и безопасности.// Доказательная гастроэнтерология. — 2020, Т. 9, No1 — C. 50–67Журавлева М.В.исоавт. Клиническая фармакология препаратов для подготовки к диагностическим исследованиям и оперативным вмешательствам, требующим очищения кишечника: анализ параметров эффективности и безопасности.// Доказательная гастроэнтерология. - 2020, Т. 9, No1 -C. 50-67.Chandrasekhara V., Lightdale J.R., FonkalsrudL etal.Bowel preparation before colonoscopy. Gastrointestinal Endoscopy. 2015;81(4):781–793Chandrasekhara V, Lightdale JR, FonkalsrudL etal.Bowel preparation before colonoscopy. Gastrointestinal Endoscopy. 2015;81(4):781-793.Lim J., Park H., Lee H. et al. Higher frailty burden in older adults with chronic constipation. BMC Gastroenterol. 2021; 25;21(1):137. DOI: 10.1186/s12876-021-01684-xLim J, Park H, Lee H et al. Higher frailty burden in older adults with chronic constipation. BMC Gastroenterol. 2021; 25;21(1):137. doi: 10.1186/s12876-021-01684-x.Sundbøll J. et al. Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study. BMJ Open. 2020; 1;10(9)SundbøllJ et al. Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study. BMJOpen. 2020; 1;10(9)Sumida K. et al. Constipation and risk of death and cardiovascular events. Atherosclerosis. 2019; 281:114–120Sumida K et al. Constipation and risk of death and cardiovascular events. Atherosclerosis. 2019; 281:114-120Lian W.Q., Li F.J., Huang H.X., Zheng Y.Q., Chen L.H. Constipation and risk of urinary incontinence in women: a metaanalysis. Int Urogynecol J. 2019; 30(10):1629–1634. DOI: 10.1007/ s00192-019-03941-w. Epub 2019 Apr 4. PMID: 30949731Lian WQ, Li FJ, Huang HX, Zheng YQ, Chen LH. Constipation and risk of urinary incontinence in women: a meta-analysis. Int Urogynecol J. 2019; 30(10):1629-1634. doi: 10.1007/s00192-019-03941-w. Epub 2019 Apr 4. PMID: 30949731.Zheng S., Yao J. Chinese Geriatric Society, Editorial Board of Chinese Journal of Geriatrics. Expert consensus on the assessment and treatment of chronic constipation in the elderly. AgingMed (Milton). 2018; 16;1(1):8–17. DOI: 10.1002/agm2.12013. PMID: 31942474Zheng S, Yao J; Chinese Geriatric Society, Editorial Board of Chinese Journal of Geriatrics. Expert consensus on the assessment and treatment of chronic constipation in the elderly. AgingMed (Milton). 2018; 16;1(1):8-17. doi: 10.1002/agm2.12013. PMID: 31942474;Ye B., Chen C.X. The anxiety depression and sleep condition of hospitalized elderly patients with chronic constipation. Chin J Gerontol. 2016;36:1996–1998Ye B, Chen C.X. The anxiety depression and sleep condition of hospitalized elderly patients with chronic constipation. Chin J Gerontol. 2016;36:1996-1998.Chu H., Zhong L., Li H., et al. Epidemiology characteristics of constipation for general population, pediatric population, and elderly population in China. Gastroenterol Res Pract. 2014;2014:532734Chu H., Zhong L., Li H., et al. Epidemiology characteristics of constipation for general population, pediatric population, and elderly population in China. Gastroenterol Res Pract. 2014;2014:532734.Ke M.Y., Wang Y.K. Epidemiology and research progress of chronic constipation in the elderly. PractGeriatr. 2010;24:92–94Ke M.Y., Wang Y.K. Epidemiology and research progress of chronic constipation in the elderly. PractGeriatr. 2010;24:92-94.Suares N.C., Ford A.C. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta analysis. Am J Gastroenterol. 2011;106:1582–1591Suares N.C., Ford A.C. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta analysis. Am J Gastroenterol. 2011;106:1582-1591.Gallegos-Orozco J., Foxx-Orenstein A., SterlerS.. Chronic constipation in the elderly. Am J Gastroenterol. 2012;107:18–25Gallegos-Orozco J., Foxx-Orenstein A., SterlerS.. Chronic constipation in the elderly. Am J Gastroenterol. 2012;107:18-25.Vazquez R.M., Bouras E.P. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015;10:919–930Vazquez R.M., Bouras E.P. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015;10:919-930.Camilleri M., Lee J.S., Viramontes B., Bharucha A.E., Tangalos E.G. Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. J Am Geriatr Soc. 2000;48(9):1142–1150Camilleri M., Lee J.S., Viramontes B., Bharucha A.E., Tangalos E.G. Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. J Am Geriatr Soc. 2000;48(9):1142–1150.Yu S.W., Rao S.S. Anorectal physiology and pathophysiology in the elderly. Clin Geriatr Med. 2014;30(1):95–106Yu S.W., Rao S.S. Anorectal physiology and pathophysiology in the elderly. Clin Geriatr Med. 2014;30(1):95–106.Bernard C.E., Gibbons S.J., Gomez-Pinilla P.J., et al. Effect of age on the enteric nervous system of the human colon. NeurogastroenterolMotil. 2009;21(7):746–e46Bernard C.E., Gibbons S.J., Gomez-Pinilla P.J., et al. Effect of age on the enteric nervous system of the human colon. NeurogastroenterolMotil. 2009;21(7):746–e46.Lagier E., Delvaux M., Vellas B., et al. Influence of age on rectal tone and sensitivity to distension in healthy subjects. NeurogastroenterolMotil. 1999;11(2):101–107Lagier E., Delvaux M., Vellas B., et al. Influence of age on rectal tone and sensitivity to distension in healthy subjects. NeurogastroenterolMotil. 1999;11(2):101–107.Madsen J.L., Graff J. Effects of ageing on gastrointestinal motor function. Age Ageing. 2004;33(2):154–159Madsen J.L., Graff J. Effects of ageing on gastrointestinal motor function. Age Ageing. 2004;33(2):154–159.Melkersson M., Andersson H., Bosaeus I., Falkheden T. Intestinal transit time in constipated and non-constipated geriatric patients. Scand J Gastroenterol. 1983;18(5):593–597Melkersson M., Andersson H., Bosaeus I., Falkheden T. Intestinal transit time in constipated and non-constipated geriatric patients. Scand J Gastroenterol. 1983;18(5):593–597.Wiskur B., Greenwood-Van Meerveld B. The aging colon: the role of enteric neurodegeneration in constipation. Curr Gastroenterol Rep. 2010;12(6):507–512Wiskur B., Greenwood-Van Meerveld B. The aging colon: the role of enteric neurodegeneration in constipation. Curr Gastroenterol Rep. 2010;12(6):507–512.Evans J.M., Fleming K.C., Talley N.J., Schleck C.D., Zinsmeister A.R., Melton L.J. Relation of colonic transit to functional bowel dis- ease in older people: a population-based study. J Am Geriatr Soc. 1998;46(1):83–87Evans J.M., Fleming K.C., Talley N.J., Schleck C.D., Zinsmeister A.R., Melton L.J. Relation of colonic transit to functional bowel dis- ease in older people: a population-based study. J Am Geriatr Soc. 1998;46(1):83–87.Meier R., Beglinger C., Dederding J.P, et al. Influence of age, gender, hormonal status and smoking habits on colonic transit time. Neurogas- troenterolMotil. 1995;7(4):235–238.Meier R., Beglinger C., Dederding J.P, et al. Influence of age, gender, hormonal status and smoking habits on colonic transit time. Neurogas- troenterolMotil. 1995;7(4):235–238.Bannister J.J, Abouzekry L., Read N.W. Effect of aging on anorectal function. Gut. 1987;28(3):353–357Bannister J.J, Abouzekry L., Read N.W. Effect of aging on anorectal function. Gut. 1987;28(3):353–357.Laurberg S., Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum. 1989;32(9):737–742Laurberg S., Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum. 1989;32(9):737–742.McHugh S.M., Diamant N.E. Effect of age, gender, and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci. 1987;32(7):726–736McHugh S.M., Diamant N.E. Effect of age, gender, and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci. 1987;32(7):726–736.Orr W.C., Chen C.L. Aging and neural control of the GI tract: IV. Clinical and physiological aspects of gastrointestinal motility and aging. Am J PhysiolGastrointest Liver Physiol. 2002;283(6):G1226–G1231Orr W.C., Chen C.L. Aging and neural control of the GI tract: IV. Clinical and physiological aspects of gastrointestinal motility and aging. Am J PhysiolGastrointest Liver Physiol. 2002;283(6):G1226–G1231.Rao S.S., Go J.T. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010 Aug 9;5:163–71. doi: 10.2147/cia.s8100. PMID: 20711435; PMCID: PMC2920196Rao S.S., Go J.T. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010 Aug 9;5:163-71. doi: 10.2147/cia.s8100. PMID: 20711435; PMCID: PMC2920196.Satish S.C. Constipation in the older adult. UpToDate May 20, 2020Satish S.C. Constipation in the older adult. UpToDate May 20, 2020.Mari A., Mahamid M., Amara H., Baker F.A., Yaccob A. Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management. KoreanJFamMed. 2020;41(3):139–145Mari A., Mahamid M., Amara H., Baker F.A., Yaccob A. Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management. KoreanJFamMed. 2020;41(3):139-145O'Mahony D., Cherubini A., Guiteras A.R. et al. STOPP/ START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023;14(4):625–632O'Mahony D., Cherubini A., Guiteras A.R.et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023;14(4):625-632Bouras E.P., Tangalos E.G. Chronic constipation in the elderly. Gastroenterol Clin North Am. 2009; 38:463Bouras EP, Tangalos EG. Chronic constipation in the elderly. Gastroenterol Clin North Am. 2009; 38:463.Kyle G.A. Guide to managing constipation: part two. Nurs Times. 2007;103:42–43Kyle G.A. Guide to managing constipation: part two. Nurs Times. 2007;103:42-43.Locke G.R., Pemberton J.H., Phillips S.F. AGA technical review on constipation. American Gastroenterological Association. Gastroenterology. 2000;119:1766–1778Locke G.R., Pemberton J.H., Phillips S.F. AGA technical review on constipation. American Gastroenterological Association. Gastroenterology. 2000;119:1766-1778.Gallegos-Orozco J., Foxx-Orenstein A., Sterler S. Chronic constipation in the elderly. AmJGastroenterol. 2012;107:18–25Gallegos-Orozco J., Foxx-Orenstein A., Sterler S. Chronic constipation in the elderly. AmJGastroenterol. 2012;107:18-25.Zhang Y.Y., Ning X.L., Lin L.Z., et al. Application of cognitive behavioral intervention on senile habitual constipation. Med Innov China. 2015;12:106–107Zhang Y.Y., Ning X.L., Lin L.Z., et al. Application of cognitive behavioral intervention on senile habitual constipation. Med Innov China. 2015;12:106-107.Wang R.T., Li Y. Analysis of cognitive function of old people with functional constipation. JHarbinMedUniv. 2011;45:603–605Wang R.T., Li Y. Analysis of cognitive function of old people with functional constipation. JHarbinMedUniv. 2011;45:603-605.Chen C.X., Li J.M., Wang J., et al. Effect of long-term history in taking medicine and anxiety on constipation of the aged. Modern Prev Med. 2008;35:101–102Chen C.X., Li J.M., Wang J., et al. Effect of long-term history in taking medicine and anxiety on constipation of the aged. Modern Prev Med. 2008;35:101-102.Zhu L.M., Fang X.C., Liu S, et al. Multi-centered stratified clinical studies for psychological and sleeping status in patients with chronic constipation in China. Natl Med J China. 2012;92:2243–2246Zhu L.M., Fang X.C., Liu S, et al. Multi-centered stratified clinical studies for psychological and sleeping status in patients with chronic constipation in China. Natl Med J China. 2012;92:2243-2246.Kang S.J., Cho Y.S., Lee T.H. et al. Constipation Research Group of the Korean Society of Neurogastroenterology and Motility. Medical Management of Constipation in Elderly Patients: Systematic Review. J NeurogastroenterolMotil. 2021Kang S.J., Cho Y.S., Lee T.H. et al. Constipation Research Group of the Korean Society of Neurogastroenterology and Motility. Medical Management of Constipation in Elderly Patients: Systematic Review. J NeurogastroenterolMotil. 2021Gwee K.A., Ghoshal U.C., Gonlachanvit S. et al. Primary care management of chronic constipation in Asia: the ANMA chronic constipation tool. J NeurogastroenterolMotil2013;19:149–60Gwee K.A., Ghoshal U.C., Gonlachanvit S. et al. Primary care management of chronic constipation in Asia: the ANMA chronic constipation tool. J NeurogastroenterolMotil2013;19:149-60.Gao R., Tao Y., Zhou C., Li J., Wang X., Chen L., Li F., Guo L. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. ScandJGastroenterol. 2019;54(2):169–177. DOI: 10.1080/00365521.2019.1568544. Epub 2019 Mar 7. PMID: 30843436Gao R., Tao Y., Zhou C., Li J., Wang X., Chen L., Li F., Guo L. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. ScandJGastroenterol. 2019;54(2):169-177. doi: 10.1080/00365521.2019.1568544. Epub 2019 Mar 7. PMID: 30843436.Towers A.L., Burgio K.L., Locher J.L., Merkel I.S., Safaeian M., Wald A. Constipation in the elderly: influence of dietary, psychological, and physi-ological factors. JAmGeriatrSoc1994;42:701–6Towers A.L., Burgio K.L., Locher J.L., Merkel I.S., Safaeian M., Wald A. Constipation in the elderly: influence of dietary, psychological, and physi-ological factors. JAmGeriatrSoc1994;42:701-6.Suares N.C., Ford A.C. Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment PharmacoloTher 2011;33:895–901Suares N.C., Ford A.C. Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment PharmacoloTher2011;33:895–901.Cheskin L.J., Kamal N., Crowell M.D., Schuster M.M., Whitehead W.E. Mechanisms of constipation in older persons and effects of fiber compared with placebo. J Am Geriatr So 1995;43:666–669Cheskin L.J., Kamal N., Crowell M.D., Schuster M.M., Whitehead W.E. Mechanisms of constipation in older persons and effects of fiber compared with placebo. J Am Geriatr So 1995;43:666-669.Emmanuel A., Mattace-Raso F., Neri M.C., Peterson K.U., Rey E., Rogers J. Constipation in older people: a consensus statement. IntJClinPract 2017;71:e12920Emmanuel A., Mattace-Raso F., Neri M.C., Peterson K.U., Rey E., Rogers J. Constipation in older people: a consensus statement. IntJClinPract 2017;71:e12920.Wang H.J., Liang X.M., Yu Z.L., Zhou L.Y., Lin S.R., Geraint M. A randomised, controlled comparison of low-dose polyethylene glycol 3350 plus electrolytes with ispaghula husk in the treatment of adults with chronic functional constipation. Clin Drug Investig 2004;24:569–576Wang H.J., Liang X.M., Yu Z.L., Zhou L.Y., Lin S.R., Geraint M. A randomised, controlled comparison of low-dose polyethylene glycol 3350 plus electrolytes with ispaghula husk in the treatment of adults with chronic functional constipation. Clin Drug Investig2004;24:569-576.Wesselius-De Casparis A., Braadbaart S., Bergh-Bohlken G.E., Mimica M. Treatment of chronic constipation with lactulose syrup: results of a double-blind study. Gut 1968;9:84–86Wesselius-De Casparis A., Braadbaart S., Bergh-Bohlken G.E., Mimica M. Treatment of chronic constipation with lactulose syrup: results of a double-blind study. Gut 1968;9:84-86.Sanders J.F. Lactulose syrup assessed in a double-blind study of elderly constipated patients. J Am Geriatr Soc 1978;26:236–239Sanders J.F. Lactulose syrup assessed in a double-blind study of elderly constipated patients. J Am Geriatr Soc 1978;26:236-239.Dipalma J.A., Cleveland M.V., McGowan J., Herrera J.L. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol 2007;102:1436–1441Dipalma J.A., Cleveland M.V., McGowan J., Herrera J.L. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol 2007;102:1436-1441.Chassagne P., Ducrotte P., Garnier P., Mathiex-Fortunet H. Tolerance and long-term efficacy of polyethylene glycol 4000 (Forlax®) compared to lactulose in elderly patients with chronic constipation. J Nutr Health Aging2017;21:429–439Chassagne P., Ducrotte P., Garnier P., Mathiex-Fortunet H. Tolerance and long-term efficacy of polyethylene glycol 4000 (Forlax®) compared to lactulose in elderly patients with chronic constipation. J Nutr Health Ag- ing2017;21:429-439.Bharucha A.E., Dorn S.D., Lembo A., Pressman A. American gastroenterological association medical position statement on constipation. Gastroenterology 2013;144:211–217Bharucha A.E., Dorn S.D., Lembo A., Pressman A. American gastroenterological association medical position statement on constipation. Gastroenterology 2013;144:211-217.Shin J.E., Jung H.K., Lee T.H., et al. Guidelines for the diagnosis and treatment of chronic functional constipation in Korea, 2015 revised edi-tion. J NeurogastroenterolMotil2016;22:383–411Shin J.E., Jung H.K., Lee T.H., et al. Guidelines for the diagnosis and treatment of chronic functional constipation in Korea, 2015 revised edi-tion. J NeurogastroenterolMotil2016;22:383-411.Serra J., Pohl D., Azpiroz F., et al. European society of neurogastroenterology and motility guidelines on functional constipation in adults. NeurogastroenterolMotil 2020;32:e13762Serra J., Pohl D., Azpiroz F., et al. European society of neurogastroenterology and motility guidelines on functional constipation in adults. NeurogastroenterolMotil 2020;32:e13762.Lee-Robichaud H., Thomas K., Morgan J., Nelson R.L. Lactulose versus polyethylene glycol for chronic constipation. CochraneDatabaseSystRev 2010;(7):CD007570Lee-Robichaud H., Thomas K., Morgan J., Nelson R.L. Lactulose versus polyethylene glycol for chronic constipation. CochraneDatabaseSystRev 2010;(7):CD007570.Mounsey A., Raleigh M., Wilson A. Management of constipation in older adults. AmMounsey A., Raleigh M., Wilson A. Management of constipation in older adults. AmAttar A., Lémann M., Ferguson A., et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999; 44:226Attar A., Lémann M., Ferguson A., et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999; 44:226.Brandt L.J., Prather C.M., Quigley E.M., et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005; 100 Suppl 1:S5.Brandt L.J., Prather C.M., Quigley E.M., et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005; 100 Suppl 1:S5.Mueller-Lissner S.,Kamm M.A., Wald A. et al. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of sodium picosulfate in patients with chronic constipa- tion. Am J Gastroenterol 2010;105:897–903Mueller-Lissner S.,Kamm M.A., Wald A. et al. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of sodium picosulfate in patients with chronic constipa- tion. Am J Gastroenterol 2010;105:897-903.Kamm M.A., Mueller-Lissner S., Wald A., Richter E., Swallow R., Gessner U. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol 2011;9:577–83Kamm M.A., Mueller-Lissner S., Wald A., Richter E., Swallow R., Gessner U. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol 2011;9:577-83.Passmore A.P., Davies K.W., Flanagan P.G., et al. A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Pharmacology 1993; 47 Suppl 1:249Passmore A.P., Davies K.W., Flanagan P.G., et al. A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Pharmacology 1993; 47 Suppl 1:249.Самсонов А.А., Парцваниа-Виноградова Е.В., Андреев Д.Н., Маруща А.В. Лаксативная болезнь: современный взгляд на проблему .// Фарматека.- 2017, №2Quigley E.M., Vandeplassche L., Kerstens R., Ausma J. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation--a 12-week, randomized, double-blind, placebo-controlled study. Aliment PharmacolTher 2009; 29:315.Quigley E.M., Vandeplassche L., Kerstens R., Ausma J. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation — a 12- week, randomized, double-blind, placebo-controlled study. Aliment PharmacolTher 2009; 29:315Müller-Lissner S., Rykx A., Kerstens R., Vandeplassche L. A double-blind, placebo-controlled study of prucalopride in elderly patients with chronic constipation. NeurogastroenterolMotil 2010; 22:991.Müller-Lissner S., Rykx A., Kerstens R., Vandeplassche L. A double-blind, placebo-controlled study of prucalopride in elderly patients with chronic constipation. NeurogastroenterolMotil 2010; 22:991Gokce A.H., Gokce F.S. Effects of bilateral transcutaneous tibial nerve stimulation on constipation severity in geriatric patients: A prospective clinical study. Geriatricgerontologyinternatonal, 2020, Vol.20, is.2, p.101-105Gokce A.H., Gokce F.S. Effects of bilateral transcutaneous tibial nerve stimulation on constipation severity in geriatric patients: A prospective clinical study. Geriatricgerontologyinternatonal, 2020, Vol.20, is.2, p.101–105Muchtar N.J., Helianthi D.R., Nareswari I. Effectiveness of Acupuncture for Management in a Hospitalized Geriatric Patient with Constipation. MedAcupunct. 2020;32(2):116-120. doi:10.1089/acu.2019.1401Muchtar N.J., Helianthi D.R., Nareswari I. Effectiveness of Acupuncture for Management in a Hospitalized Geriatric Patient with Constipation. MedAcupunct. 2020;32(2):116–120. DOI: 10.1089/acu.2019.1401Inkaya B., Tuzer H. Effect of Reflexology on the Constipation Status of Elderly People. YonagoActaMed. 2020;63(2):115-121. doi:10.33160/yam.2020.05.007Inkaya B., Tuzer H. Effect of Reflexology on the Constipation Status of Elderly People. YonagoActaMed. 2020;63(2):115–121. DOI: 10.33160/yam.2020.05.007.Inkaya B., Tuzer H. Effect of Reflexology on the Constipation Status of Elderly People. YonagoActaMed. 2020;63(2):115–121. DOI: 10.33160/yam.2020.05.007.

The authors declare that there are no conflicts of interest present.