For second-line management of functional constipation in the elderly, which osmotic laxative is more effective with fewer side effects?

For second-line management of functional constipation in the elderly, which osmotic laxative is more effective with fewer side effects?

• A. Lactulose
• B. Sorbitol
• C. Polyethylene glycol
• D. Magnesium hydroxide

Answer: (C)

When treating constipation in older adults, choosing an osmotic laxative that works well yet minimizes GI upset and systemic risks is key. Osmotic laxatives pull water into the colon to soften stool, but how they do this matters for tolerance. Polyethylene glycol stands out because it is largely nonabsorbed and not drastically fermented by gut bacteria. This means it effectively increases stool water and softens stool without producing a lot of gas, bloating, or cramps. In contrast, lactulose and sorbitol are fermented in the colon and frequently cause bloating, flatulence, and discomfort, which elderly patients often poorly tolerate. Magnesium hydroxide, while effective, can accumulate in individuals with reduced renal function and cause electrolyte disturbances, making it riskier in the elderly population. So, polyethylene glycol provides solid stool-smoothing benefits with fewer GI side effects and a safer electrolyte profile, making it the best choice among these options for second-line management in older adults.

When treating constipation in older adults, choosing an osmotic laxative that works well yet minimizes GI upset and systemic risks is key. Osmotic laxatives pull water into the colon to soften stool, but how they do this matters for tolerance.

Polyethylene glycol stands out because it is largely nonabsorbed and not drastically fermented by gut bacteria. This means it effectively increases stool water and softens stool without producing a lot of gas, bloating, or cramps. In contrast, lactulose and sorbitol are fermented in the colon and frequently cause bloating, flatulence, and discomfort, which elderly patients often poorly tolerate. Magnesium hydroxide, while effective, can accumulate in individuals with reduced renal function and cause electrolyte disturbances, making it riskier in the elderly population.

So, polyethylene glycol provides solid stool-smoothing benefits with fewer GI side effects and a safer electrolyte profile, making it the best choice among these options for second-line management in older adults.