Although people of all ages become constipated from time to time, research shows that this gastrointestinal disorder is more prevalent in older adults—especially women and residents of long-term care facilities.
It’s important to understand that constipation isn’t a disease; it is a symptom of another underlying issue or issues. While constipation usually is not a serious concern, the resulting discomfort can greatly affect an elder’s quality of life, and chronic symptoms may lead to complications.
Family caregivers should familiarize themselves with the symptoms and possible causes of constipation in the elderly as well as viable treatments to ensure their loved ones’ comfort and digestive health.
Constipation Symptoms in Elderly Individuals
According to the National Institute of Diabetes and Digestive and Kidney Diseases, symptoms of constipation may include:
- fewer than three bowel movements (BMs) per week
- stools that are hard, dry or lumpy
- stools that are difficult or painful to pass
- a feeling that not all stool has passed
Other symptoms may include a feeling of “fullness” and abdominal bloating, distention, and pain.
How Often Should an Elderly Person Have a Bowel Movement?
“Every person’s body, metabolism and eating habits are different, therefore there is no single definition of normalcy when it comes to the frequency of bowel movements,” says Kim English, RN, BScN, MN, professor at the Trent/Fleming School of Nursing in Peterborough, Ontario, Canada. “Many elders subscribe to the myth that one should defecate at least once every day, but there is no such magic number or prescribed schedule that people should aim for.”
English says that “normality” falls within a range of no more than three movements a day and no less than three movements each week. Falling just outside this range is not necessarily a cause for concern unless other troubling symptoms are present. Each person knows their own body best and what is considered normal for them.
For example, if an otherwise healthy senior has always generally had few BMs per week but never experienced straining, abdominal discomfort or other symptoms associated with constipation, then that may very well be their normal baseline. On the other end of the spectrum, another healthy senior may typically have one or two bowel movements per day. If this schedule changes and is accompanied by discomfort or other warning signs, English advises making a doctor’s appointment.
What Causes Constipation in Seniors?
Constipation is a complex condition that can have many different causes. One contributing factor may be to blame or several. Reasons for occasional constipation may include:
- Dehydration
- Eating a low-fiber diet
- Physical inactivity
- Certain prescription and over-the-counter medications
- Certain dietary supplements
- Changes in routine
- Ignoring the urge to have a BM
- Stress
Preventing and Treating Occasional Constipation
If an aging loved one is experiencing intermittent constipation, the first thing to do is identify causes like recent changes in their lifestyle, health status and medication regimen. These sort of fluctuations are typically to blame for occasional constipation and will help guide you in choosing the best method(s) for prevention and treatment.
The following recommendations can not only help prevent and alleviate minor constipation in many cases, but they are also fundamental aspects of a healthy lifestyle for people of all ages.
- Increase fluid intake. (Unless a doctor has recommended fluid restrictions to manage a chronic condition, such as congestive heart failure.)
- Eat more healthy, high-fiber foods like beans, nuts, whole grains, fruits and vegetables.
- Increase activity levels by walking or starting a senior-friendly exercise regimen.
- Use responsible medication management practices, including documentation of new or worsening side effects (like constipation) to address with a doctor or pharmacist.
If the options above do not improve a senior’s symptoms of occasional constipation, or their condition worsens, then it’s important to make an appointment with their doctor to discuss other treatment options. Fiber supplements, stool softeners and other laxatives are widely available without a prescription, but they can have bothersome side effects and even interact with other medications a senior is taking. It’s best to consult a physician regarding laxative use and rule out more serious underlying issues.
Monitoring for Constipation in the Elderly
An important (but admittedly unglamorous) part of being a family caregiver is keeping an eye out for changes in an aging loved one’s bathroom habits. These can happen gradually or suddenly, so establishing a baseline to reference is crucial. (Keeping a food diary and stool diary can be very helpful for seniors who are prone to digestive issues.)
Some caregivers find that their care recipients are a little too forthcoming and descriptive when it comes to talking about BMs—even if there isn’t a problem. If you find yourself in this situation, it may be difficult to get used to at first. However, this open communication can help you monitor their digestive health and overall health as long as the information your loved one provides is reliable.
On the other hand, some older adults understandably keep these very personal matters to themselves, which makes monitoring much more difficult. Be sure to gently encourage your care recipient to share any new or worsening symptoms (digestive or not) with you as soon as they happen. Their physician may be a helpful ally in overcoming awkwardness and facilitating candid conversation.
If your elder is particularly tightlipped, then you’ll need to be extra attentive in this area and likely others. Look for subtle changes like eating less, complaining about abdominal discomfort or vague digestive symptoms, itching or discomfort that may indicate the presence of hemorrhoids or anal fissures from straining to “go,” or spending more or less time in the bathroom. These changes may warrant a doctor’s appointment.
While occasional constipation is common and can often resolve or improve with a few healthy lifestyle changes, it’s important to seek medical attention if a senior is constipated for more than a couple weeks, begins experiencing severe pain or has blood in their stools. These symptoms may indicate chronic constipation or a more serious underlying condition, such as diverticulitis or colon cancer.
Sources: Management of Constipation in Older Adults (https://pubmed.ncbi.nlm.nih.gov/26371734/); Concerned About Constipation? (https://www.nia.nih.gov/health/concerned-about-constipation); Epidemiology and management of chronic constipation in elderly patients (https://dx.doi.org/10.2147%2FCIA.S54304)