Clinical bottom line
Chronic constipation is a prevalent and often under-recognized issue in older adults with multimorbidity, significantly impacting quality of life and healthcare utilization. Current evidence supports a multifaceted management approach combining lifestyle modification, pharmacologic treatment tailored to individual risk profiles, and adjunctive therapies such as abdominal massage and probiotics. Emerging data suggest that non-pharmacologic interventions, including automatic abdominal massage, may offer safe, effective symptom relief and improve bowel function in this population. Clinicians should assess constipation proactively, considering multimorbidity and polypharmacy, and apply individualized, evidence-based strategies to optimize outcomes.
What the evidence shows
Constipation in older adults with multimorbidity arises from multifactorial causes including reduced mobility, medication side effects, and comorbid gastrointestinal dysfunction. Toner et al. (2012) and Huang Shiou Yun et al. (2025) emphasize the importance of comprehensive assessment and prevention strategies, including dietary fiber optimization, hydration, and physical activity, alongside careful medication review to minimize constipating agents.
Pharmacologic management remains a cornerstone but requires caution due to altered pharmacodynamics and increased susceptibility to adverse effects in older adults. Nazarko et al. (2017) highlight the need for individualized laxative selection and monitoring for efficacy and safety.
Recent trials have advanced the evidence base for adjunctive non-pharmacologic therapies. Huang Shiou Yun et al. (2025) report that automatic abdominal/waist massage significantly improved bowel movement frequency and reduced symptom severity in older adults with chronic constipation, suggesting a promising, low-risk intervention suitable for those with limited mobility or polypharmacy concerns. Zhang Nicole et al. (2025) corroborate these findings in a meta-analysis, confirming abdominal massage as a safe and effective adjunct to standard care in adults with chronic constipation.
Probiotics have also garnered attention; Coombs et al. (2025) demonstrate that oral probiotic supplementation may alleviate constipation symptoms and improve stool consistency in older adults, although heterogeneity in strains and dosing warrants further investigation.
Caveats and uncertainty
Despite encouraging findings, the evidence base has limitations. Many studies, including those on abdominal massage and probiotics, involve relatively small sample sizes and short follow-up durations, limiting generalizability and long-term efficacy assessment. The heterogeneity of constipation definitions and outcome measures complicates cross-study comparisons.
The interplay of multimorbidity and polypharmacy in older adults introduces complexity in attributing constipation to specific causes and predicting response to interventions. Furthermore, the optimal probiotic strains, doses, and treatment durations remain uncertain, and automatic abdominal massage devices require validation in diverse clinical settings.
Clinical guidelines often extrapolate from younger or less complex populations, underscoring the need for geriatric-specific trials and pragmatic studies addressing real-world multimorbidity and frailty.
How this may change practice
Clinicians managing older adults with multimorbidity should adopt a proactive, multifactorial approach to constipation, integrating thorough assessment with tailored interventions. Non-pharmacologic therapies such as abdominal massage may be considered as adjuncts or alternatives to pharmacologic agents, particularly in patients at risk for medication-related adverse effects or with limited mobility.
Incorporating probiotic supplementation could be beneficial, but clinicians should remain cautious pending further evidence on optimal regimens. Regular reassessment and deprescribing of constipating medications remain critical components of care.
Education of patients and caregivers on lifestyle modifications and self-management strategies is essential, as is interdisciplinary collaboration involving nursing and allied health professionals to implement and monitor non-pharmacologic interventions.
Overall, these evolving strategies may enhance symptom control, reduce reliance on laxatives, and improve quality of life in this vulnerable population.