Large bowel problems.

Some large bowel disorders are common to all age groups, others are commoner in the elderly. Colonic function is complex and not fully understood. Diarrhoeal states tend to cause faecal incontinence in the elderly and constipation is commoner in immobile institutionalised elderly patients. Two types of constipation have been identified requiring different approaches in treatment. The management of constipation includes the treatment of the underlying cause and the clearing of the bowel using enemas and suppositories given rectally and laxatives given orally. The neurological causes of faecal incontinence may be local or more commonly cortical. Deliberate constipation and planned evacuation of the rectum may help to reduce the frequency of faecal incontinence. The management of diverticular disease centres around fibre and bulking agents. The treatment of ulcerative colitis and Crohn's disease is similar to that in younger patients.