Constipation and Aging

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:

  • Bowel movements that feel incomplete
  • Strain or feelings of pain when you try to eliminate
  • Gas pains or a bloated abdomen
  • Fissures, or tiny cracks, in your anus, usually from straining
  • Hemorrhoids or swollen tissue around your anus -- these symptoms usually result from "hard" stools or straining to produce stool rather than from pure constipation.
  • Blood streaks in your stool from tiny fissures or hemorrhoids
  • Anorexia or loss of appetite
  • In demented persons, signs of constipation may include increased confusion or somnolence

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:

  • Your diet is low in fiber
  • You don't get enough fluids (6 to 8 glasses a day)
  • You get less than 30 minutes of exercise a day
  • You are immobile or bedridden due to illness or disability
  • You often ignore the urge to move your bowels
  • You overuse laxatives or enemas
  • You have irritable bowel syndrome, also known as spastic colon, an annoying but usually harmless condition that can cause alternating bouts of diarrhea and constipation
  • You have scarring, tumors or another condition in your digestive tract that prevents it from functioning properly
  • You have a disease such as multiple sclerosis, lupus, scleroderma, underactive or overactive thyroid, or diabetes, all of which can affect a broad range of body functions
  • You take certain medications such as antihistamines, iron supplements, diuretics, certain high blood pressure medicines, and antacids that contain aluminum and calcium

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:

  • Add high-fiber foods to your menu: whole grains, vegetables, nuts, and fresh or dried fruits such as figs, berries, apricots, or prunes. If chewing or swallowing raw vegetables is a problem, then eat them cooked. Whole-grain cereals and high-fiber bran flakes sprinkled on casseroles and other dishes is another option.
  • Cut down on high-fat foods, such as fatty meats and cheese, and avoid refined sugars.
  • Drink at least eight 8-ounce glasses of water daily, and perhaps a glass of juice as well. (Prune juice really does work as a mild laxative.) Be careful about drinking too much milk, though, because it can lead to constipation.
  • Limit caffeinated drinks (such as colas, coffee, alcoholic drinks and tea) that tend to be dehydrating.
  • Try to get regular exercise, such as 30- or 45- minute daily walks, because increased activity often relieves constipation. (Check with your doctor before initiating an exercise program, though.)
  • Heed your body's warning signs when you need to go to the bathroom, but don't strain or rush.
  • Consider biofeedback -- this has been used to treat constipation, with some success, according to the NIDDK.
  • Talk with your doctor about any medications that may be causing constipation -- he or she may be able to prescribe another kind.

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 and also have a swollen abdomen and experience steady or severe cramps and vomiting, go to an emergency or urgent care center.

References

Mayo Clinic. Constipation. http://www.mayoclinic.com/health/constipation/DS00063

National Institute of Diabetes and Digestive and Kidney Diseases. Constipation. http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/

Hsieh C. Treatment of constipation in older adults. American Family Physician.

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