By Laurie Udesky
What is constipation?
If you've ever exchanged tips about eating prunes or drinking lots of water to stay regular, then you've probably had personal experience with constipation.
More than 4 million Americans feel constipated frequently, according to a National Institutes of Health survey. Although constipation is common in all age groups, people over age 65 suffer from it the most. Constipation is a problem for less than 2 percent of people who aren't elderly, but the rate is considerably higher in people over age 65.
Constipation is generally thought to be less of a problem of digestion than motility, a technical word for the muscle contractions that move feces through the gut. The main factors that put you at risk for constipation are generally the same as in younger people -- lack of exercise, a low-fiber diet and low fluid intake.
Some seniors may be constipated simply because they don't get enough to eat. You may also find yourself constipated if you're lactose intolerant or if you don't -- or can't -- exercise; metabolic disorders or weak muscle tone can also contribute to irregularity. You may also take a medication that's constipating, such as Pepto Bismol, aluminum antacids, narcotics, diuretics, antipsychotics or tricyclic antidepressants, calcium channel blockers, iron supplements, nonsteroidal anti-inflammatory agents, and some anticonvulsants.
As for where the problem originates, your colon is generally the culprit, since that's where the fluid is removed from the stool in the bowel.
Constipation occurs when contractions in the colon are irregular or there's not enough water in your intestines to move the stool into the lower bowel and out of the system. At that point, you may find yourself unable to defecate.
No matter what's causing it, of course, constipation can be more than an annoyance. Gastroenterologists, who often deal with the most stubborn cases of irregularity, point out that although it's seldom life-threatening, chronic constipation can erode a person's quality of life.
How often should I have a bowel movement?
Just because you don't have a bowel movement every day doesn't mean you're constipated. Some people have a bowel movement two to three times a day, others every three days. If you go for more than three days without one, however, your stool may harden, making it more difficult to eliminate.
In rare cases, new or progressively worse constipation may be a symptom of another, more serious problem, such as colorectal cancer or medication toxicity. If your symptoms last more than three weeks, call a doctor. Bloating, gas, cramps, abdominal pain, and alternating diarrhea and constipation, and rectal bleeding are symptoms that should prompt concern and perhaps result in a visit or call to your physician, especially if this is a new bowel pattern.
What are the symptoms of constipation?
Try to be aware of changes in your bowel movements. Symptoms of constipation include:
What causes constipation?
Everything from the kind of food you eat to how physically active you are -- even whether you go to the toilet as soon as you feel the urge -- affects how regular you are. People who get plenty of fluid and a variety of fruits, vegetables, and whole grains during the day tend not to suffer from constipation: Fiber and fluid keep stools from becoming hard and dry, and promote motility of the gastrointestinal tract.
Conversely, you're more likely to be constipated if:
How do you treat constipation?
Minor constipation in seniors usually responds well to a change in diet. Fiber is a tried-and-true remedy for constipation, especially when it's accompanied by regular exercise and plenty of water each day. (Temporary side effects from increasing your fiber intake can include bloating and flatulence, so adding fiber gradually is a good idea.)
Be sure to see your doctor if your constipation lasts more than three weeks or if you've gone more than four days without a bowel movement, especially if you have other symptoms such as bloating, cramps, pain, and an unusual amount of gas.
If your constipation isn't the result of disease, simply altering your diet or adding extra fiber may get your bowels back in order. Here are a few suggestions:
Should I take laxatives?
Americans spend about hundreds of millions of dollars on laxatives annually, according to the National Institute of Diabetes and Digestive and Kidney Diseases, but they are often unnecessary. Eating a high-fiber diet, staying physically active, and drinking lots of fluids is usually enough to solve the problem. If you need extra help, a natural "fiber" laxative such as psyllium (found in Metamucil) is generally safe and effective in small doses.
Milk of Magnesia or other mild magnesia containing laxatives are considered safe and effective, even over long periods of time. They work by attracting more fluid into the fecal contents of the colon and therefore moving the stool more easily through the gut. (They should be avoided in persons who have kidney failure, however.)
Use stimulant laxatives only as a last resort and only for a short period, or if your doctor prescribes them for you. Although stimulant laxatives help produce rhythmic muscle contractions in the intestine and push stool through to the rectum, prolonged use can train your system to depend on them, result in an enlarged intestine and rectum, and eventually lead to more constipation. These laxatives, including castor oil, bisacodyl, and senna, should be avoided because they can cause vomiting, cramping, and other serious side effects, especially in older people, according to the Medical Sciences Bulletin; their long-term use can lead to dependence. In unusual cases, this dependence results in loose watery stools, it can also dehydrate your body and lead to dangerous electrolyte imbalances.
Another laxative ingredient to be wary of is mineral oil. When used as a laxative, it allows stool to move more easily through the intestines, but it can interfere with absorption of certain vitamins and medications, including blood-thinning medicines, according to the National Institute on Aging. It can also cause a certain type of pneumonia (lipid pneumonia) if it is inadvertently inhaled into the lungs.
Is constipation serious?
Even a long-standing pattern of constipation is usually not serious, particularly if the pattern is stable. Only if the colonic muscles are paralyzed or if there is a major obstruction of the bowels is it likely to be medically serious. Constipation is also serious if it's associated with symptoms that interfere with your daily functioning or quality of life.
In rare cases, constipation can be a sign of a tumor or of fecal impaction, a serious condition that occurs when a collection of stool obstructs the passage of stool behind it, and stool backs up in the intestines and blocks them. A fecal impaction usually requires enemas and/or manual removal (by gloved hand). When it occurs lower in the colon near the anus, it is easily removed. When it occurs high in the colon, it may be more difficult to remove and require more aggressive measures.
Whatever the cause, if you're more constipated than usual, have a swollen abdomen, and experience steady or severe cramps and vomiting, go to an emergency or urgent care center.
Mayo Clinic. Constipation. January 2009. http://www.mayoclinic.com/health/constipation/DS00063
National Institute of Diabetes and Digestive and Kidney Diseases. Constipation. July 2007. http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/
Hsieh C. Treatment of constipation in older adults. American Family Physician, December 1, 2005.
Last Updated: March 11, 2013
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