Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination

BMJ. 1993 Sep 25;307(6907):769-71. doi: 10.1136/bmj.307.6907.769.


Objectives: To compare the efficacy and cost effectiveness of a senna-fibre combination and lactulose in treating constipation in long stay elderly patients.

Design: Randomised, double blind, cross over study.

Setting: Four hospitals in Northern Ireland, one hospital in England, and two nursing homes in England.

Subjects: 77 elderly patients with a history of chronic constipation in long term hospital or nursing home care.

Intervention: A senna-fibre combination (10 ml daily) or lactulose (15 ml twice daily) with matching placebo for two 14 day periods, with 3-5 days before and between treatments.

Main outcome measures: Stool frequency, stool consistency, and ease of evacuation; deviation from recommended dose; daily dose and cost per stool; adverse effects.

Results: Mean daily bowel frequency was greater with the senna-fibre combination (0.8, 95% confidence interval 0.7 to 0.9) than lactulose (0.6, 0.5 to 0.7; t = 3.51 p < or = 0.001). Scores for stool consistency and ease of evacuation were significantly higher for the senna-fibre combination than for lactulose. The recommended dose was exceeded more frequently with lactulose than the senna-fibre combination (chi 2 = 8.38, p or = 0.01). As an index of the standard daily dose, the dose per stool was 1.52 for lactulose and 0.97 for the senna-fibre combination, at a cost per stool of 39.7p for lactulose and 10.3p for senna-fibre. Adverse effects were no different for the two treatments.

Conclusions: Both treatments were effective and well tolerated for chronic constipation in long stay elderly patients. The senna-fibre combination was significantly more effective than lactulose at a lower cost.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Constipation / drug therapy*
  • Constipation / economics
  • Cost-Benefit Analysis
  • Double-Blind Method
  • Drug Combinations
  • Drug Costs
  • Female
  • Hospitalization
  • Humans
  • Lactulose / economics
  • Lactulose / therapeutic use*
  • Long-Term Care
  • Male
  • Senna Extract / economics
  • Senna Extract / therapeutic use*


  • Drug Combinations
  • Lactulose
  • Senna Extract