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As a Physiotherapist working with families taking care of old folks, I often get inundated with questions from such families about constipation in their elderly loved ones and how to relieve their symptoms. Many families complain about the considerable discomfort and distress their senior ones experience quite often, when they attempt to make a bowel movement. Constipation is also a source of ongoing stress and concern for families who are looking after their seniors. 

Constipation is an issue that many seniors deal with quite frequently. The condition can affect their quality of life in general, making them irritable, avoid meals and exercise. Elderly folks and their families may also have a wrong assumption of what constipation means, as popular opinion suggests that not having a bowel movement daily means the person is constipated. This has led to wrong use of laxatives, creating a bigger problem by interfering with the natural process of emptying the bowels. In reality, folks don’t have to have a daily bowel movement to be considered normal. Constipation is defined as fewer than three bowel movements per week. What this means is that if the senior doesn’t have any bowel movement in three days, that’s too long as the stools may have become harder and more difficult to pass.

Causes of constipation in the elderly

A poor diet low in fibre, inadequate fluids in the diet, physical inactivity, use of certain drugs to treat pre-existing medical conditions and poor bowel habits are some of the causes which can make it difficult for the elderly to poop. There is a psychological angle too, as many seniors are excessively concerned about their bowel movements and may have ‘imaginary constipation’.

Loss of interest in eating is quite common in single or widowed older people, causing over reliance on convenience foods, most of which are very low in fiber. In addition, loss of dentition may make it more difficult to eat regular meals and thus, many seniors resort to having soft, processed foods which are also low in fiber.

Stress and Urinary incontinence is quite common in the elderly too. As a result, many seniors take inadequate fluids to reduce frequency of urination. This has the effect of making them constipated as water and other fluids add bulk to stools and soften stools.

Quite often, many seniors are not getting enough exercise as a result of one condition or the other, which keeps them in bed for extended periods. This, in addition to the age related slowing or weakening of the digestive system can contribute to constipation.  

Use of prescription drugs have also been implicated as one of the causal factors of constipation in the elderly. Some of these medications include antacids, opiates for pain, antidepressants, antihistamines, diuretics. 

Anxiety over constipation is quite common in the elderly too. This has the effect on making older people to rely on laxatives. Over time, this becomes habitual and the natural bowel mechanism fails to work without recourse to these laxatives.

Symptoms of constipation

Passing fewer than three stools per week
Having lumpy or hard stools
Straining or trouble having a bowel movement
Few bowel movements
Feeling like bowels not totally emptied

POSSIBLE SOLUTION

Families taking care of their elderly ones should remove or greatly limit the amount of ‘constipating’ diets from the menu. These generally includes foods with low fibre content, such as dairy products, cereals with less than 1g of fibre per serving, e.g some cornflakes, rice crispies, puffed wheat, white rice, noodles and macaroni etc . It’s important to note that, on their own, these foods don’t cause constipation, but it’s likely to happen when coupled with physical inactivity, slowing down of the digestive system, prescription meds for other conditions and inadequate water intake common in the elderly.

Regularly give them foods like whole wheat bread, whole grains like brown rice, Ofada rice, oatmeal, corn, millet, beans, Adalu (Nigerian delicacy of beans mixed with corn)

They should be encouraged to regularly eat fruits, e.g apples, bananas, berries, watermelons with the outer covering, pears etc. Vegetables, such as carrots, okra, spinach, broccoli, bitter leaf etc.  Nuts such as pistachios, walnuts, almonds, peanuts etc

Exercising regularly is great for overall health and helps to regulate the digestive system, particularly as it begins to slow down in the elderly. Encourage your seniors to engage in exercises and other sporting activities like leisure walks, bike riding, swimming when possible, playing indoor games like table tennis etc.

Help them to establish a bathroom routine. Having a daily routine, where your seniors’ makes an effort to at least visit the loo at same time everyday is a great idea. However, any other time the urge comes is fine as well.

Importantly too, encourage your seniors to drink water often, not just at meal times. Water helps with the digestion of food and prevents constipation by adding bulk and softening stools.

Families and caregivers looking after seniors should understand that constipation can be an intractable issue for the elderly. Having the right information about this problem, will make them approach the matter with more understanding and empathy, and provide the necessary support to help the seniors navigate through the challenges, which can impact positively on their quality of life.

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