Constipation in the Elderly

Contributing Factors and Possible Treatments

Constipation can be uncomfortable and when left untreated can become a serious issues.

There are a number of factors related to aging that can contribute to constipation in the elderly, including: medications, general loss of muscle tone, decreased physical activity, decreased taste/smell, eating and drinking less and more difficulty with functional activities such as preparing meals.

The first thing that should be done is a visit to the person's physician to rule out any other medical reasons that might exist. Bring a list of medications as these can often contribute to constipation in the elderly.

The physician can investigate the cause for constipation and make changes to the treatment. They may also recommend strategies such as enema, suppository or liquid fiber supplement that should be recommended through a doctor.

Elderly with a history of bowel problems such as colitis, colon polyps, cancer of the colon, anal fissures, severe hemorrhoids require specialized care from their physician.

After consulting a physician, possible remedies for constipation include: physical activity, increasing fiber and water intake and stool softeners.

Contributing Factors

1) Medications:

There are many medications that might play a role in developing constipation. Some of these are pain medications such as morphine, codeine, oxycodone; anticholinergic medications (contained in many over-the-counter sinus, sleep, allergy and cold medications); older antidepressants and antipsychotics, narcotics and some heart medications.

2) Loss of Muscle Tone:

Another impacting factor regarding constipation in the elderly is the loss of muscle tone as part of the aging process. This will affect both sphincter muscles, involved in the actual discharge of waste from the body, and the muscles of the intestine that depend on waves of muscular contraction to move digested food.

The sphincter muscles can be toned through exercises (most often kegel exercises are prescribed) but the muscles of the intestines most likely cannot. Because of this, it may be normal for bowel movements to slow to every other day or even once every three days but this can be reviewed with the senior's doctor. A physical therapist can assist the elderly with exercises to tone the muscles of the sphincter.

3) Diet:

Diet and fluid intake are major elements in the risk of developing constipation in the elderly. Part of the normal aging process is a decrease in both taste and smell.

Bitter and sour taste/smell usually decrease first but loss of sweet taste/smell is also common. Because of this many frail seniors are left with cravings for sweets and carbohydrates. We call all picture the elderly lady or man who lives only on tea and toast.

4) Eating and Drinking Less:

Another effect on diet is that seniors often eat and drink less in general. Eating less decreases the amount of food that moves through the system which will then decrease the regularity of bowel movements. Decreased fluid consumption can lead to constipation as fluids serve to keep waste softer and more mobile.

Elderly rarely drink the recommended amount of fluid per day (approximately 8 glasses). Although caffeinated beverages count towards fluid intake, more fluid is required due to the diuretic (causing increased urination) quality of caffeinated fluids. Some medications effect fluid absorption and can be discussed with the physician involved.

Elderly often have a tendency to not make full meals due to issues such as fatigue or disinterest due to depression; or they live alone and "can't be bothered". Another reason why tea and toast might be very appealing!

When discussions around food come up with groups of seniors or individual seniors, it is amazing how often they report an inadequate diet and are either not aware of their poor diet or are past caring. Seniors seldom eat enough fruits or vegetables and fiber intake can also be an issue.

Constipation in the elderly can be caused by a diet low in fiber and high in foods with more fat such as cheese, eggs and meats. See tips for addressing constipation below for more information about dietary changes that can be made.

Tips

After consulting a physician:

• Physical activity - Increase physical activity or exercise
• Get up and walk - Get up and walk around once an hour to promote better intestinal motility
• Exercise - Consider seeking community programs that focus on exercise and wellness in the elderly
• Food and Drink - Unless chronic diseases such as heart or kidney disease are a factor, the following can be done to increase normal bowel movements and decrease constipation:
• Increase fiber in the diet but only accompanied by increased fluid intake as well (if only fibre is increased, hard waste will be formed that will be very difficult to move. Fluid is needed to make waste softer and more mobile!)
• Examples of helpful fibers: bran, 5 or more servings of fresh fruit - particularly grapes, raisins, prunes, prune juice - multigrain bread, beans, vegetables such as asparagus, brussel sprouts, cabbage and carrots
• Monitoring the amount of foods higher in fat such as cheese, eggs and meat and accompanying them with veggies and fruits as often as possible
• Increase fluid intake, particularly non-caffeinated beverages (water is the best!)
• Salt to a minimum (reduce body retaining water in tissues of ankles and feet instead of absorbing into intestines
• Nutritionist/dietician consult may be helpful in regards to the best changes to make to the diet
• Massage - Massage may be another consideration
• Laxatives and stool softeners - On consultation with a physician: laxatives, enemas, suppositories, stool softeners, liquid fibre (can cause bloating/ gas in some people)

Why Can Constipation Be Such A Focus in the Elderly?

Many seniors have a fear of losing control of their bodily functions. Certainly the thought of being incontinent, particularly of bowel, can be quite embarrassing and impacting for the elderly.

Bowel movements often become inconsistent and this can become an overwhelming focus as seniors may worry about having an accident; something no adult would wish to happen.

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