Managing Constipation in the Older Adult

Constipation is defined as having fewer than three bowel movements a week (Mayo Clinic 2019). Constipation also encompasses the passing of hard, dry bowel motions (stools) that are infrequent, difficult to pass, or both (Better Health Channel 2014).

Constipation can usually be prevented and treated by maintaining a high fibre diet, increasing water intake and exercising regularly (Better Health Channel 2014).

Constipation is a medical issue to be taken seriously, particularly when present in the older adult. Older adults are considered to be a primary at-risk group for chronic constipation. It is estimated that older adults are five times more likely to develop constipated-related problems (Mandal 2019).

The process of digestion is as follows: when food is consumed, it breaks down in the stomach and passes through the intestine. The walls of the intestine then absorb nutrients from the food. The waste that remains is then passed through the colon and rectum. At times this process is disturbed, and waste becomes lodged in the colon, this is known as faecal impaction of the colon (Khan 2017).

Symptoms of Constipation

• Needing to open bowels less frequently;
• Hard, dry stools that might be hard to pass;
• Painfully straining to pass a bowel motion;
• Feeling as though there is a blockage preventing bowel movement;
• Having to sit on the toilet for long periods of time;
• A sensation that the bowel has not fully emptied after a motion;
• Having a bloated abdomen; and
• Abdominal cramps.

(Better Health Channel 2014; Mayo Clinic 2019).

Constipation can be the result of more serious illnesses and events, including tumours and systemic diseases (Better Health Channel 2014).

Constipation in Elderly People

There are many reasons why constipation affects older adults. One is as a side-effect of certain medications such as medications for pain, antidepressants, anticonvulsants, and antihistamines, or a result of medical conditions such as strictures, hypothyroidism, tumours or Parkinson’s disease. Prolonged bed rest, perhaps during illness, resulting in a decrease in movement (Daily Caring 2019; Mandal 2019).

Other reasons include:

• A possible lack of interest with regard to eating (frequently seen in single or widowed older people) resulting in the consumption of low-effort food, which is typically low in fibre.
• Slowing or weakening of the digestive system as a result of ageing and/or frailty.
• Poor diet or lack of adequate fluids in diet, and/or a lack of exercise.
• Urinary/stress incontinence is common in older adults.
• Absence of teeth can make it difficult to eat regular meals.

(Daily Caring 2019; Mandal 2019)

Common Types of Constipation in the Elderly

• Normal transit constipation: a common type of primary constipation. Though a stool passes through the colon at a regular pace, patients perceive difficulty in passing bowel motions. This is often associated with IBS.
• Slow-transit constipation: predominately affects women. Bowel movements are infrequent, limited in their urgency or straining is involved.
• Pelvic floor dysfunction: patients are experiencing difficulty in coordinating pelvic floor muscles or muscles around the anus during defecation. This often creates a feeling of an incomplete bowel motion.

(Mandal 2019)

Risk Factors for Constipation

Being older than 65 is a major risk factor for chronic constipation. Other risk factors include:

• Being female;
• Being pregnant;
• Being ill;
• Dehydration;
• Insufficient fibre intake;
• Lack of physical activity;
• Mental health issues such as depression or having an eating disorder;
• Taking regular medication for which constipation is a side-effect.

(Djordjevic 2018; Better Health Channel 2014)

Complications of Constipation

• Haemorrhoids: swollen or damaged blood vessels in the anus;
• Anal fissure: torn skin in the anus, this can be caused by a hard or large stool;
• faecal impaction: faecal matter in the lower bowel that cannot be passed;
• Rectal prolapse: a section of the intestine protrudes from the anus;
• Faecal incontinence: the inability to control bowel movements;
• Urinary incontinence: constant straining can weaken pelvic floor muscles.

(Mayo Clinic 2019; Better Health Channel 2014)

Diagnosis

Diagnosis can involve a detailed medical history, a physical examination, questions relating to diet, exercise and lifestyle habits, a colonoscopy or a combination of these (Mandal 2019; Better Health Channel 2014).

From this examination, the cause of constipation – such as drug-induced constipation, constipation as a result of prolonged inactivity, and changes in diet and fluid intake – can be identified (Mandal 2019).

Constipation Treatment

Foods to Encourage:

• Soluble fibres: legumes, fruits, nuts, seeds and vegetables; and
• Insoluble fibres: wheat bran, wholegrain bread and cereals.

(Better Health Channel 2014; Mayo Clinic 2019)

Foods to Limit:

• Processed foods;
• Dairy;
• Refined grains (such as white rice); and
Red meat.

(Mayo Clinic 2019; Better Health Channel 2014; Daily Caring 2019)

Drinking adequate amounts of water is a known strategy for preventing and aiding constipation. Water softens stools and stimulates the bowel (Daily Caring 2019).

If a person’s diet is lacking in fibre and they are reluctant to eat certain foods, consider advising the intake of a fibre supplement (Better Health Channel 2014).

Laxatives are a treatment option for constipation if diet and lifestyle modifications do not provide a solution. There are two primary types of laxatives: osmotic laxatives and bowel stimulants. Laxatives should be used appropriately to avoid adverse effects (Better Health Channel 2014; Mounsey et al. 2015).

Exercise

Regular exercise is known to aid and regulate digestion. The minimum amount of exercise recommended is 30 minutes per day. In the case of an older person and/or where mobility issues are apparent, activity should be encouraged. Every small bit of exercise makes a difference (Better Health Channel 2014).

Manage Stress

It has been shown that depression and mood disorders can trigger constipation. Yoga, meditation or other relaxation techniques may aid this (MedicineNet 2018).

Create a Routine

Try to establish a regular bathroom time in which an older adult tries to empty their bowels each day. In addition to this routine, they should be encouraged to go as soon as they feel the urge (Daily Caring 2019).

Prevention

• Maintaining a high-fibre diet;
• Avoiding processed foods;
• Drinking plenty of water;
• Exercising;
• Managing stress;
• Having a regular schedule for bowel evacuation; and
• Not ignoring the urge to pass stools.

(Mayo Clinic 2019; Better Health Channel 2014)

Additional Resources

• The Continence Foundation: https://www.continence.org.au/

References

• Better Health Channel 2014, Constipation, Better Health Channel 2014, viewed 9 October 2019, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/constipation
• Cunha, J 2019, ‘12 Foods for Constipation Relief’, MedicineNet, viewed 9 October 2019, https://www.medicinenet.com/top_foods_for_constipation_relief/article.htm
• Daily Caring Editorial Staff, 6 Simple Solutions for Chronic Constipation in Seniors, Daily Caring, viewed 9 October 2019, https://dailycaring.com/6-simple-solutions-for-chronic-constipation-in-seniors/
• Djordjevic, N 2018, ‘Causes and Management of Constipation in Elderly People’, Med Alert Help, viewed 9 October 2019, https://medalerthelp.org/constipation-in-elderly/
• Khan, A 2017, ‘Impacted Bowel’, Healthline, viewed 9 October 2019, https://www.healthline.com/health/fecal-impaction
• Mandal, A 2019, ‘Constipation in the Elderly’, News Medical Life Sciences, viewed 9 October 2019, https://www.news-medical.net/health/Constipation-in-the-Elderly.aspx
• Mayo Clinic Staff 2019, Constipation, Mayo Clinic, viewed 9 October 2019, https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253
• MedicineNet 2018, Digestive Disorders: 23 Constipation Myths and Facts, MedicineNet, viewed 9 October 2019, https://www.medicinenet.com/constipation_myths_facts_pictures_slideshow/article.htm
• Mounsey, A, Raleigh, M and Wilson, A 2015, ‘Management of Constipation in Older Adults’, American Family Physician, 92(6), pp. 500-504

(Answers: b, b, c)