Constipation simply means infrequent passage of stool (feces). It is a condition in which you have fewer than three bowel movements a week with mostly hard and dry stools. Most often, constipation is not a cause of an underlying disease.
Constipation in the elderly is generally overlooked or not managed properly. Usually, constipation is five times more common in the elderly when compared to the younger population. The reasons for constipation in the elderly include dehydration, lack of fiber in the diet, no or minimal physical activity, and medications.
Constipation in old people can happen for many reasons, such as when stool passes through the colon too slowly. The slower the food moves through the digestive tract, the more water the colon will absorb and the harder the feces will become.
Sometimes, constipation results from a blockage in the large intestine. In this case, you will need urgent medical attention. At other times, it may simply be due to a lack of fiber or water.
Read on to know more about “pebble poop” (constipation) in the elderly.
Symptoms
The main symptoms for constipation are characterized as:
Difficulty in passing stool
Straining when passing stool
Passing less stool than usual
Lumpy, dry, or hard stool
Associated symptoms of constipation include:
Pain and cramping in the abdomen
Feeling bloated
Nausea
A loss of appetite
Causes Leading to Constipation in Elderly
Lack of fiber in the diet. Fiber promotes regular bowel (the tube that carries waste food away from your stomach to the place where it leaves your body) movement.
Physical inactivity. If you spend several days or weeks in bed or sitting in a chair, you may have a higher risk of constipation.
Irritable Bowel Syndrome (IBS). IBS is an intestinal disorder causing pain in the stomach, wind (gas), and constipation. The intestine is the tubular part that extends from your stomach to the anus.
Aging. As you age, food takes longer to pass through the digestive tract. You also become less mobile after a certain age, which may also contribute to constipation.
Changes in routine. Eating meals, going to bed, and using the bathroom at different times than usual could increase the risk of constipation.
Overuse of laxatives. Laxatives are substances that loosen stools and increase bowel movements. But regular use of certain laxatives allows your body to get used to their action. When you stop taking them, it increases the risk of severe constipation.
Avoiding going to the bathroom when needed. The longer you delay, the drier and harder the stool will become.
Not getting enough water. Increasing water content inside the gut can help soften stools and stimulate your bowel movements. Hence, an adult should consume two to three liters of water every day to stay hydrated and keep bowel movements healthy.
Medications to treat other medical conditions like anticholinergic drugs can lead to constipation.
Types of Constipation in the Elderly
There are several subtypes of constipation in the elderly depending on the transit of the feces, such as:
Normal transit constipation is the most common type where the stools pass through your colon normally, however, you experience difficulty in evacuating the bowel. This symptom is usually seen with irritable bowel syndrome along with abdominal pain and discomfort.
Slow transit constipation is more commonly seen in women. In this type, the slow movement of the bowel in the colon leads to less bowel movement, limited urgency to void, or straining while defecating.
Pelvic floor dysfunction is when there is damage to the muscles of your pelvic and anal region. Due to this the muscle coordination to move and pass the bowel is disturbed. You may experience the feeling of incomplete evacuation. In certain cases, there is an overlap between slow transit constipation and pelvic floor dysfunction.
Problems in the Elderly
Constipation is not a life-threatening condition, however, in the elderly, constipation can cause a great deal of discomfort than in younger individuals. Damages that can result from a severe case of constipation include:
Rectal bleeding after straining. This can cause you discomfort and pain while defecating. The rectum is where feces or stools are stored temporarily before coming out of the anus (posterior opening for the feces to come out).
Anal fissure, a small tear around the anus can occur which may require surgical intervention.
Hemorrhoids (piles), which are swollen, inflamed blood vessels in the anus, causing discomfort.
Fecal impaction, which occurs when dried stool stagnates and collects in the rectum and anus, potentially leading to mechanical obstruction.
Reduced quality of life due to constant discomfort and fatigue.
Home Remedies to Treat or Prevent Constipation in the Elderly
In most older adults with constipation, there are no red flags or signs of mechanical obstruction.
To treat these cases of constipation, geriatricians usually use a step-wise approach. Geriatrics is a branch of medicine that deals with the health and care of old individuals and the practitioners are called geriatricians.
Stay hydrated. It is advisable to drink around 2 to 3 liters of water every day but if you have constipation, you can have two to four extra glasses of water a day. Avoid caffeine-containing drinks and alcohol, which can lead to dehydration.
Add fruits, vegetables, and whole grains (high fiber foods) to your diet. Fiber helps speed up the transit of food in your digestive tract and helps prevent constipation. Eat fewer high-fat foods, like meat, eggs, and cheese.
Maintain a food diary and single out foods that constipate you.
Exercise. Get moving. Do mild to moderate exercises for at least 20 minutes a day.
Try other sitting postures while defecating like raising your feet, leaning back, or squatting. This may make your bowel movement easier.
Add over-the-counter supplements such as vitamin B9 (folic acid), methylcellulose to your diet.
Folic acid stimulates the formation of digestive acids and methylcellulose works by making the stool softer by increasing the amount of water hence making stool easier to pass.Take a very mild over-the-counter stool softener or laxative. Laxatives work by drawing water to the bowel from the surrounding tissue to soften and moisten the stool and also helps in increasing your bowel activity.
- Do not use laxatives for more than two weeks without calling your doctor. Do not read, use your phone or other devices while trying to clear your bowels.
When Should the Elderly Seek Help for Constipation?
You should seek medical attention for constipation if you have:
Severe discomfort or worsening symptoms of constipation.
Constipation starts suddenly without a clear reason.
Ongoing constipation that has not responded to lifestyle changes.
Blood in the stool or bleeding from the rectum.
Constant pain in the abdomen or lower back.
Difficulty in passing gas.
Constipation along with fever, vomiting, and unexpected weight loss.
If possible, it is best to resolve constipation using home remedies, such as eating more fiber, drinking more water, and getting regular exercise. However, in severe and persistent cases you may need urgent medical attention.
References:
1. Aafp.org. 2021. Management of Constipation in Older Adults. [online] Available at: <https://www.aafp.org/afp/2015/0915/p500.html#:~:text=Chronic%20constipation%20is%20common%20in,medication%20use%2C%20and%20psychosocial%20issues.> [Accessed 4 March 2021].
2. PubMed Central (PMC). 2021. Constipation in older adults: Stepwise approach to keep things moving. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325863/> [Accessed 4 March 2021].
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