Constipation in the Elderly – Causes, Prevention, and Management Strategies

Constipation in the Elderly – Causes, Prevention, and Management Strategies
Updated on April 24, 2019

A study done by the University of North Carolina reveals that acute constipation is prevalent in seniors who are over 60 years of age. Symptoms are more common in 50% of those living in nursing homes. While most people shy off from openly talking about it, constipation is an issue that anyone will have to face at some point in their life. Sadly, constipation knows no age, fame, or class. Even the once hailed Prince of Soul, the late Marvin Gaye was quoted saying “I wish that being famous helped prevent me from being constipated”. Clearly, constipation is a cause for agony and sleepless nights especially among the elderly.

 

What is constipation?

In simple terms, constipation is the hardening of your stool. It means that your bowel movements occur less often than normal. Skipping three days without passing poop is considered too long a time and could most likely result in constipation. This is because, after three days, your stool becomes toughened and difficult to pass. If you pass hard stools continuously for more than three months it means that your condition is acute. This condition is also accompanied by straining when passing stool which is why people feel tired and their strength sapped after constipation. In critical cases, a patient will visit the toilet less than once per week. Constipation could also be an indication of an underlying disease in your body.

 

Fecal impaction

Fecal impaction is a common condition in the elderly population. It is a condition that develops from chronic or serious elderly constipation complications and occurs when large volumes of stool build up in one’s colon for some time such that they struggle to push it out. If untreated, fecal impaction may result in death. A common cause of fecal impaction is high dependence on laxatives when constipating such that one does not recognize the urge to pass stool when it arises.

 

What causes constipation in the elderly?

More often, constipation in elderly people is caused by more than one factor. This is because a good percentage of seniors are usually on medication for one condition or the other. Some main causes of constipation in older patients include:

  • Poor diet. Some of the foods like unripe bananas, wheat, barley, dairy products, red meat, and spelt which contain gluten have closely been linked to constipation.
  • Eating disorders. Anorexia nervosa and bulimia are surprisingly prevalent in the elderly population. These often lead to a restrictive eating habit hence causing an eating disorder.
  • Urinary and stress incontinence. The avoidance of taking fluids perhaps because they are bothered by rushing to the washroom every other time is a possibility. In addition, seniors may do so to avoid the embarrassment caused by urine leaking out. The downside of this decision is that less fluid in the system causes hardening of stool.
  • Loss of interest in food. Lack of appetite may lead to constipation because the body does not get enough food to create waste for emission. Still, taking small portions of food with high fiber content may not really help to alleviate hard stool. This is because less frequent bowel movement has been linked to low-calorie consumption. Lack of appetite can also cause one to buy fast food, which is usually low in fiber, out of convenience.
  • The medication being taken to treat other conditions. Prescriptions and over the counter drugs like antidepressants, antihistamines, and diuretics can cause hard poop when taken over a long time or when taken together.
  • Lack of exercise. Elderly constipation complications can be relieved by exercising regularly. Physical activity helps to contract the bowel muscles which eases the process of excretion.
  • Dependence on laxatives due to the fear of constipation. Using stool softeners for long periods can cause your colon to rely on them rather than the normal contraction process that leads to the elimination of stool. In effect, one will not sense the urge to poop causing stool to stay in the system for long hence constipation.
  • Suppressing bowel movement. Holding back the elimination of poop for long is not advisable for the older generation. The longer one suppresses it the more water it releases making it tougher and harder to expel.

 

Signs of constipation in seniors

  • Lesser bowel movements
  • Straining when passing poop
  • Tough stool coming out in small portions
  • Pain in the abdomen
  • Vomiting
  • Feeling like some stool is still left in your bowels even after relieving yourself
  • Lack of energy and a feeling of laziness
  • Loss of interest in food
  • Having a stomach full of gas

 

Nursing management of constipation in the elderly

Nursing management of constipation in the elderly

In the Constipation in the elderly guidelines put forward by the National Academies of Sciences, Engineering, and Medicine it is recommended that females aged between 31-50 years should consume at least 25g of fiber daily. Men in the same age bracket need 38g. As you advance in years, your fiber requirement decreases. Ladies aged over 51 need 21g daily while their male counterparts require 30g. Fiber is an excellent remedy for constipation. In addition, constipation treatment in elderly people can be achieved by including the following foods in their diet:

  • Baked beans
  • Black-eyed peas
  • Lima peas
  • Pinto and kidney beans
  • Kiwifruit
  • Sweet potatoes
  • Popcorns
  • Nuts
  • Whole grain bread
  • Pears
  • Plums
  • Apples
  • Plenty of vegetables
  • Plenty of fluids and water

On the other hand, caregivers should ensure that older patients avoid or limit the following foods so as to lower the risk of constipation in them:

  • Chewing gum
  • White rice
  • Persimmon (a fruit common in Asia)
  • Red meat
  • White bread
  • Coffee, tea, and alcohol

Other constipation in the elderly management strategies are:

  • Exercise. A physically active body decreases the amount of time that food takes to go through the large intestines. This increases water absorption into the stool making it soft and easy to pass.
  • Bowel training. The most effective relief for constipation is through bowel control. Help your elderly parent by defining the best time for them to pass stool i.e. after waking up and a little while after taking meals. Also, they need to know when the urge to poop arises and relieve themselves immediately. Finally, when passing stool, a semi-squatting position enhances the process of eliminating of poop. Use a footstool or bend forward when sitting on the toilet.
  • Pelvic muscle training therapy. The pelvic floor is lined with muscles that manage defecation in the body. With the help of a therapist, you can train the muscles by tightening and relaxing them, as if you want to pass urine and then holding it.
  • Colonic massage. Use your fingertips to make small circular massaging movements towards the direction of your intestines. This gives you an instant relief to hard feces.

 

Treatment options

Elderly constipation treatment

Laxatives are drugs that you can use to enhance bowel movement. They help in loosening up the stool. They are the most prescribed and the immediate go-to option for relief from constipation.
Below are laxatives that you can use in constipation treatment for adults.

  • Stool softeners. These are drugs like Colace that moisten poop by drawing water from the intestines into the poop hence increasing bowel movement. It is important to note that mineral oil is not the best stool softener for elderly constipation cases as it reduces fat-soluble vitamins in the body.
  • Fiber supplements. Fiber supplements are never digested by your system. Instead, they become part of your poop and because they are good at fluid absorption, make it bulky, softer, and easier to pass. Soluble fiber supplements like psyllium are highly recommended constipation treatment elderly people find effective..
    Stimulants. Stimulants like Dulcolax facilitate bowel movement by stimulating muscle contraction in the colon.
  • Lubricants. used to help your stool slide out easily through the colon
  • Osmotics. Osmotic laxatives like GlycoLax facilitate the retention of water in the stool making it soft and easy to move through the colon.
  • Enemas. This is the insertion of liquid or air into your colon through the rectum to enhance bowel movement. This option is suitable in cases of fecal impaction and should not be used frequently or without the recommendation of a physician.
  • Rectal suppository. A rectal suppository is a dosage that looks like an inch long bullet that is inserted through the rectum and then melts to get rid of hard stools

 

Can constipation be prevented?

The keys to preventing constipation in elderly people are more or less the same as home remedies for constipation. These include:

  • Eating a lot of fruits.
  • Consuming lots of vegetables because of their high fiber content.
  • Having whole grain for breakfast.
  • Drinking a lot of water. At least 6-8 glasses a day is good for the body.
  • Finding time to relax. A hectic schedule keeps you extremely busy and this diverts the focus that you need to give to your body including the urge to go to the toilet. Allowing yourself more time to go to the toilet will help alleviate chronic constipation.

 

Doctor visit checklist

Doctor visit checklist - elderly constipation

Everyone has a problem with going to the toilet at some point in their life. If you do not experience frequent bowel movements you should not be worried at all. Constipation disappears on its own within some days or after taking stool softeners. When hard stools become a part and parcel of your life, you need to visit a doctor. It is essential for an elderly patient to carry a checklist with the below details to help with faster diagnosis and resolution of their problem.

  • A list of symptoms you have been experiencing. These are signs that should point you to seeking for help such as using a lot of energy when defecating, stool that has blood, and the significant reduction in bowel activity
  • Medications being taken. Indicate every prescription and over the counter drugs that you are currently using.
    Personal information. Provide detailed information about your health history and also carry any laboratory test results that you have.
  • Who is accompanying you? Aging patients should always be taken to the doctor by their caregiver, adult children, or someone trustworthy who is familiar with them.
  • A list of questions to ask your doctor. Ask questions about your diagnosis, treatment, and seek for health tips if possible to help you understand your situation better or help you when you need to seek a second opinion.

 

Conclusion

Elderly people suffer more from constipation because of the fear or the embarrassment associated with talking about it openly. Constipation is a common condition that most people suffer from and it is treatable in the hospital and/or at home. It is important for the elderly to be sensitized to the importance of informing their caregivers when they suspect that they are suffering from constipation. More importantly, seniors should be educated about how to prevent constipation given that the consequence of this condition can be fatal. Proper eating habits, regular exercise, and a prompt response to the urge to pass stool are some simple habits one can adapt to their daily lives to reduce the risk of constipation.

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