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Constipation is a common problem among older adults, and it can cause considerable discomfort and stress. If not treated, it could lead to health complications. Let’s look at the causes of constipation and how to prevent it.
What is constipation?
Constipation means that bowel movements are difficult or infrequent (fewer than three times per week). This happens when stools move through the large intestine (bowel) too slowly and the body absorbs much of the water they contain. As a result, stools are dry, hard or lumpy, making them difficult or even painful to pass from the body. Normal stools are soft and easy to eliminate.
Older adults are particularly susceptible to constipation, and prevalence increases with age. Medical research has found that among people age 65 and older, 26% of women and 16% of men experience constipation; among people aged 84 and older, it affects 34% of women and 26% of men. Constipation is considered chronic if symptoms continue for three weeks or more.
Symptoms of constipation
Constipation can cause several symptoms, including:
- Feeling bloated or full
- Abdominal discomfort, cramping or pain
- Flatulence (gassiness)
- Excessive straining during bowel movements
- Small, hard, lumpy stools, or longer lumpy stools
- Feeling like the bowel isn’t completely emptied
- Pressure on the rectum, or feeling like it is blocked
- General malaise or feeling sluggish
- Loss of appetite
Causes of constipation
There are many possible causes, including the following:
- Dehydration, or not drinking enough fluids each day
- Diet that is low in fibre and/or high in fats and refined sugars
- Lack of physical activity
- Slow metabolism
- Depression, anxiety or stress
- Side effect of certain medications (opioids, antidepressants,
antacids, calcium channel blockers and more) and
supplements (such as iron or calcium pills)
- Ignoring the urge to have a bowel movement
- Overuse of stool softeners (laxatives), suppositories
- A change in routine (for example, when travelling)
- Health conditions or disease treatments that affect the bowel
If you or a senior loved one frequently experiences constipation, don’t ignore it. Over time, constipation can cause unpleasant and painful complications, including hemorrhoids and anal fissures (caused by excessive straining on the toilet), weakening of muscles and ligaments around the rectum, and fecal impaction (blockage in the bowel).
Fecal impaction can become severe quickly; it is considered a medical emergency. If there has been no bowel movement for a prolonged period of time, and you notice symptoms such as abdominal discomfort or pain, bloating, loss of appetite, nausea or vomiting, headaches or unexplained weight loss, seek medical attention. Another possible symptom is diarrhea, or leakage of liquid feces that has squeezed past the blockage in the bowel.
Making lifestyle changes can help reduce and prevent constipation. Here are steps you can take:
Gradually increase the amount of fibre in your diet. Soluble fibre helps to keep water in your digestive system, while insoluble fibre (roughage) helps to bulk up stools and make them soft and easy to pass. Good choices for fibre-rich foods: vegetables, fruit, legumes (lentils, chickpeas, beans, peas), whole grains and products made with whole grains (breads, cereals, pasta, etc.), nuts and seeds (flax, chia, bran). According to Dietitians of Canada, women over age 51 need 21 grams of fibre daily; men over 51 need 30 grams daily. As you increase your fibre intake (slowly, to allow your body to adjust), increase your fluid intake as well.
Men should drink 12 cups (3 litres) of fluid daily. Women should drink 9 cups (2.2 litres). Older adults should be especially careful to drink enough, as dehydration can contribute to low blood pressure, dizziness, fainting and falls. Choose water most of the time. Other fluids such as soup, broth, coffee, tea, milk and juice also count.
Exercise is good for the whole body, and it can help keep you regular. Try to go for at least one 15-minute walk each day, and add more activity if you can. Adults age 65 and older should aim for 150 minutes of moderate to vigorous exercise per week, according to the Canadian Physical Activity Guidelines. (Before starting any new physical activity, consult your physician.)
Other ways to relieve constipation
If necessary, there are remedies for relief of constipation, including eating prunes or drinking prune juice, taking medications or supplements, and other approaches. Talk to your pharmacist or physician about suitable options, which may include stool softeners, bulk-forming agents (fibre supplements), enemas, lubricants and different types of laxatives. Be careful not to overuse laxatives, which can make constipation worse.