Causes & Management of Constipation in Elderly People
Everyone gets constipated from time to time. If you’ve ever been constipated, you know how uncomfortable it can be. Can you imagine being in that state all the time? Constipation in elderly people is a very common condition as it develops much more often in older age. Experts estimate that two-thirds of people over the age of 65 experience constipation.
Though occasional constipation can come and go without serious consequences at any age, chronic constipation requires medical attention to discover its causes so that it can be managed and prevented from repeatedly occurring in the future.
Many people think they are constipated if they don’t have a bowel movement every day. However, constipation is most often defined as having fewer than three bowel movements a week. Furthermore, chronic constipation in elderly people manifests as infrequent bowel movements or difficult passage of stool that lasts for at least several weeks.
While we can usually identify an underlying cause, there are instances when we cannot determine what causes an older adult to be constipated. Fortunately, there are ways to prevent and treat constipation even when we can’t determine what caused it.
In this post, we will cover the signs and symptoms of constipation, the complications that may arise from it, and all the potential causes and types of constipation, as well as its diagnosis, treatment, and prevention. Let’s begin.
Signs and Symptoms of Constipation in the Elderly
In order to diagnose constipation, two or more of the symptoms we’ll list need to be present. The first one, obviously, being infrequent defecation. Ideally, you should have a bowel movement every day, but one every 2–3 days is also perfectly normal, that is, if it is not always accompanied by the following signs and symptoms:
- Hard and lumpy stool
- Straining during defecation
- The sense of incomplete evacuation
- The need to “help” the stool come out
A quick way to assess if your stool is normal is to take a look at the Bristol stool scale. It can reveal mild or severe constipation in elderly people and even show whether they lack fiber in their diet.
Other associated signs and symptoms can include:
- Pain in the abdomen
- Feeling of fullness
- Lack of appetite
- Irritability can be a symptom of constipation in elderly dementia patients
Complications of Chronic Constipation
If left untreated for a long time, constipation can lead to a number of complications, including the following:
- Fecal impaction (stool that can’t be evacuated): The longer it stays in the colon, the drier and harder the stool gets. Eventually, it gets stuck and becomes impossible to evacuate without treatment.
- Hemorrhoids (swollen veins around the anus): Long-term straining during defecation can lead to hemorrhoids, which can also further become complicated by bleeding.
- Anal fissures (tears in the skin of the anus): Large and hard stools can even lead to tears in the anus.
- Rectal prolapse (intestines protruding through the anus): One of the most severe complications can occur when the rectum protrudes outside due to straining.
Causes of Constipation in Elderly People
A number of issues can cause chronic constipation—from those that make the stool move too slowly to those that prevent it from being eliminated effectively, leading to hard and dry stool. Here are all the potential causes of chronic constipation:
- Blockages in the colon or rectum: These can include anal fissures, bowel obstructions, narrowing of the colon (stricture), the rectum bulging through the back wall of the vagina (rectocele), and finally colon cancer, rectal cancer, and other abdominal cancers that press on the colon.
- Issues with nerves that cause muscles in the colon and rectum to contract: The causes of constipation in seniors among these types of conditions can include a stroke, spinal cord injury, Parkinson’s disease, autonomic neuropathy, and multiple sclerosis.
- Problems with the muscles involved in stool elimination: These can be brought on by anismus (the inability to relax the pelvic muscles, which allows a bowel movement), dyssynergia (the lack of coordination between pelvic muscles in providing proper relaxation and contraction), and weakened pelvic muscles.
- Conditions that affect hormones: Finally, conditions that lead to an imbalance of hormones that control the amount of fluids in the body like diabetes, hyperparathyroidism, hypothyroidism, and even pregnancy can also lead to constipation.
Constipation Risk Factors
No less important than the specific causes are the risk factors that can be responsible for constipation in older adults. The first two of the following risk factors are clearly unmodifiable. But you can make changes to the others in order to decrease your risk of becoming constipated:
- Being older than 65
- Being female
- Not getting enough dietary fiber
- Physical inactivity
- Having mental health issues like depression or an eating disorder
- Taking medications that cause constipation in the elderly, which include certain sedatives, antihistamines, muscle relaxants, anti-nausea medications, narcotics, antidepressants, diuretics, and calcium and iron supplements.
Types of Constipation Among the Elderly
- Normal transit constipation: The most common type, in which the stool passes at a normal rate, but patients have trouble evacuating the stool. It is commonly associated with irritable bowel syndrome (IBS). However, IBS patients experience a lot more abdominal pain and discomfort.
- Slow-transit constipation: This type is more common in women. Bowel movements are slow and infrequent, there’s limited urgency, and patients strain to defecate, which can lead to various elderly constipation complications.
- Dysfunction of the pelvic floor: Some elements of slow-transit are present here as well. There are also problems with the muscles of the pelvic floor and around the anus (problems with the anal sphincter). Patients have trouble coordinating muscles during defecation, and they have a feeling of incomplete evacuation.
Your doctor will diagnose constipation based on your symptoms and a physical exam that will typically include a digital rectal exam. To confirm or exclude any specific issues that could be causing your chronic constipation, your doctor might order various additional procedures such as:
- Blood tests: To discover certain conditions causing dehydration and constipation in the elderly, for instance, low thyroid function (hypothyroidism).
- Sigmoidoscopy and/or colonoscopy: Examination of the rectum and lower (sigmoid) colon or the entire colon.
- Anorectal manometry and/or balloon expulsion test: Evaluation of the function and speed of the anal sphincter muscle.
- X-ray & MRI defecography: Visualization procedures used to see problems in the rectum during defecation.
- Colonic transit study: Used to determine how well and how fast food moves through the colon.
Treatment for Constipation in Elderly People
To begin the treatment of chronic constipation, all underlying conditions that may be causing it should first be diagnosed and properly managed. Also, a revision of all medications should be done to identify and find substitutes for those causing constipation, if possible. Then, we can proceed to implementing other lifestyle changes, drugs, procedures, and home remedies for constipation in elderly people.
Diet and Lifestyle Changes
- Drink enough fluids: Making sure to drink plenty of fluids to avoid dehydration is one of the key things in preventing your stool from becoming dry and hard.
- Increase fiber intake: Eating foods rich in fiber is another sure way of preventing constipation in elderly people. Fiber increases the overall weight of your stool and also speeds its passage through your intestines.
- Be physically active every day: Exercise increases the muscle activity in your intestines, speeding up the passage of stool.
- Don’t ignore bowel movements: Never ignore the urge to have a bowel movement. Avoiding defecation makes the stool drier and harder.
- Try creating a schedule for bowel movements: Having and maintaining a regular bowel movement schedule—for example, in the morning or after meals—is a good way to avoid becoming constipated.
If the above lifestyle changes and a proper diet for constipation in elderly patients are not effective enough in eliminating your constipation, it’s time to resort to some of the the different types of laxatives. Here are all the available laxatives we have at our disposal, either over-the-counter or by prescription:
Fiber supplements: Just like natural fiber, these supplements are designed to add bulk to your stool. Some of the fiber supplements available on the market include psyllium (Metamucil), calcium polycarbophil (FiberCon), and methylcellulose fiber (Citrucel).
Osmotics: This type of laxative helps fluids move through the bowels. Drugs from this group include magnesium hydroxide (Magnesia), magnesium citrate, lactulose (Kristalose), polyethylene glycol (Miralax), polyethylene glycol (Golytely).
Stimulants: These laxatives stimulate the contraction of intestines. Examples include Dulcolax, senna-sennosides (Senokot), Correctol, bisacodyl (Ducodyl).
Lubricants: Mineral oil-based lubricants enable easier movement of the stool through the colon.
Stool softeners: This last type of oral laxatives works by drawing water from the intestines to the stool. Some of them include docusate sodium (Colace) and docusate calcium (Surfak). However, experts doubt the effectiveness of even the best stool softener for elderly people.
Enemas and suppositories: Occasionally, for instance, if fecal impaction occurs, suppositories and enemas are needed to produce a bowel movement. But you should not become too dependant on them and ignore addressing the causes of constipation. Sodium phosphate (Fleet), soapsuds, and tap water can be used in enemas. Glycerin or bisacodyl suppositories are most commonly used to produce a bowel movement.
Pelvic Muscle Training and Surgery
If you have issues with your pelvic muscles, there are biofeedback therapists who can help you learn how to relax or tighten the muscles in your pelvis. They use special devices such as tubes that measure muscle tension in your rectum.
In the case of blockage, rectocele, anal fissures, hemorrhoids, or stricture, surgery might be the only treatment option. Rarely, parts of the rectum or colon need to be removed if cancerous tumors were identified as the cause of constipation.
How to Prevent Constipation in the Elderly
The same diet and lifestyle changes used to treat constipation should be adopted to prevent constipation from ever occurring. So drink plenty of fluids, eat lots of fiber-rich foods, avoid processed foods, be physically active, don’t ignore bowel movement urges, and try sticking to a schedule to prevent constipation.
But which foods can cause and which ones help prevent constipation? Have a look in the following table:
|Foods that cause constipation in seniors:||Foods good for constipation in the elderly:|
|Bananas||Prunes and plums|
|Caffeine||Apples and pears|
|Foods rich in gluten||Kiwi|
|Red meat||Citrus fruits|
|White bread||Spinach and other greens|
|Alcohol||Jerusalem artichoke and chicory|
|Fast food||Sweet potatoes|
|Processed foods and frozen dinners||Beans, peas, and lentils|
|Chips||Flaxseeds and chia seeds|
|Some supplements||Whole grain bread and oat bran|
|Persimmon||Nuts and seeds|
What causes constipation in the elderly?
The most common causes of constipation in old age can be classified as those resulting from a blockage in the colon or rectum, problems with the pelvic nerves or muscles, and conditions that affect hormones that control the amount of fluids in the body. Additionally, a number of risk factors also contribute to constipation, like dehydration, lack of dietary fiber, physical inactivity, depression, and eating disorders, as well as certain medications.
Do people get more constipated as they get older?
Yes, older adults, especially females over the age of 65, are more prone to constipation. In fact, over 65% of people over 65 experience chronic constipation. Experts cannot tell with certainty why we get more constipated as we get older, but the reason might be in the changes in metabolism that occur with aging, or it might be due to dehydration, which is also a common problem in the elderly.
What is the best treatment for chronic constipation?
The best treatment approach to chronic constipation affecting older adults is through diet and lifestyle changes before resolving to medications. If that doesn’t help, the next step would be to take a laxative. Different types of laxatives include fiber supplements, osmotics, stimulants, lubricants, and stool softeners. Additionally, enemas, suppositories, pelvic muscle training, and surgery may be required, depending on the cause of constipation.
What helps constipation fast?
If a spontaneous bowel movement can’t be produced even with extensive straining, fecal impaction might be the culprit. In those cases, enemas and suppositories have to be used to evacuate the stool. However, you shouldn’t take shortcuts and wait that long before addressing your chronic constipation. It’s much better to avoid having to constantly treat chronic constipation.
How can you avoid getting constipated?
You can successfully avoid getting constipated by fighting dehydration through drinking plenty of fluids, eating foods rich in fiber and avoiding foods that aren’t, exercising daily, and not ignoring the urge to have a bowel movement.
What foods make you constipated?
The foods and drinks that increase your risk of becoming constipated include bananas, caffeine, gluten, white rice, red meat, white bread, alcohol, chocolate, dairy products, fast and processed foods, chips, certain supplements, persimmon, and even chewing gum if you accidentally swallow it too often.
What foods are good for constipation?
On the other hand, to increase your fiber intake and decrease your risk of becoming constipated, you should often eat prunes and plums, apples and pears, kiwi, figs, citrus fruits, spinach and other greens, Jerusalem artichoke and chicory, artichoke, rhubarb, sweet potatoes, beans, peas, lentils, flaxseeds and chia seeds, whole grain bread and oat bran, nuts and seeds, and, yes, popcorn, which also helps fight constipation in elderly people.