Constipation can be a sensitive topic to raise for many people. However, it’s important to alert doctors and caretakers to the condition since it could be a sign that your body is not functioning at its best.
Below, we’ll take a look at the definitions of constipation as well as its symptoms, causes, and management. Understanding more about the condition can make it easier to discuss and lead to better overall health.
What is constipation?
Constipated is normally defined as having three or fewer bowel movements per week, or stools that are difficult to pass. If you experience severe pain or blood while passing stool or if you have three or fewer bowel movements a week for over three weeks, it’s important to see a doctor.
Everyone’s bowel movements are different and there’s no one definition of a “normal” schedule. In fact, some people don’t have a bowel movement every day, yet they are still not considered to be constipated if that is normal for them..
Constipation is common throughout the population with roughly 20% of people experiencing it at some point. However, it is five times more likely in the elderly (and women in particular) than in younger adults.
Signs of constipation
In addition to passing stools fewer than three times per week, there are other signs that a person may be constipated. These include:
– Straining to pass a stool
Constipation may cause you to push too hard during a bowel movement. When this happens, you can damage your rectum and cause a prolapse and further complications.
– Hard or lumpy stools
Many people have hard or lumpy stools from time to time, but when it’s a chronic condition, you may be considered constipated. These stools can be painful to pass and lead to hemorrhoids, anal fissures, or tears in the lining of the anus.
– A sense of incomplete evacuation
This is the sensation you may get when you pass a bowel movement but you feel there is more that you cannot pass without straining. You may get this feeling even if the bowel movement is complete.
– The need for “manual maneuvers”
If a stool is stuck in the rectum, it’s known as a fecal impaction. This blockage can be cleared by a laxative or enema, but occasionally warrants manual removal. This requires you, a healthcare worker, or CDPAP caretaker to insert a finger into your rectum to manually remove the stool.
What causes constipation in the elderly?
Constipation has many causes and they largely apply to people of all ages. But because constipation can result in more serious health outcomes in the elderly, it’s impotent to pay attention to the following factors:
– Poor diet
Constipation can occur in people who don’t consume enough high-fiber foods such as vegetables, fruits, and whole grains. A diet high in dairy, sugar, red meat, and dairy can also cause constipation. An elderly person who loses interest in – or the ability to – cook can easily develop a poor diet.
– Medications
Some medications can cause constipation (as detailed below), and it’s important to talk to your doctor about this side effect if it does not go away within three weeks.
– Lack of fluids
Even mild dehydration, which is common in the elderly, can reduce the water content of stools making them hard to pass.
– Lack of exercise
Exercise can help move fecal matter through your bowels. Without regular activity, bowel movements will pass slowly through the colon and lose water along the way. As a result, they become hard and painful to pass. The good news is that exercise can help relieve constipation.
– Prolonged best rest
Similar to a lack of exercise, elderly patients in bed can easily become constipated. Sedentary behavior can interfere with the movement of fecal matter through the colon.
– Anxiety
Sometimes anxiety about being or becoming sick is enough to create stress in the body. If elderly patients are concerned about their bowel movements, it’s important to have an open conversation with them to assure they have the symptoms.
– Urinary incontinence
If incontinence is an issue an elderly patient may not want to use the bathroom. Withholding bowel movements can create or worsen constipation.
Medications that may cause constipation
Medications have many side effects and it’s crucial to talk to your doctor about what is considered a “normal” reaction.
Some of the drugs known to cause constipation in some patients include:
– Anticholinergics, including antihistamines, medications for an overactive bladder, muscle relaxants, anti-nausea medications, and more
These medications are known to block acetylcholine, which is used by brain cells and by the nerves in the gut.
– Opiate painkillers, such as codeine, morphine, oxycodone
Opiates can decrease the bowel’s tone, ability to contract, increase colonic fluid, and reduce rectal sensation. All of these issues can lead to hard stools that are difficult to pass.
– Diuretics
These can cause diarrhea or constipation, depending on the person. Constipation from diuretics can usually be alleviated by staying hydrated.
– Some forms of calcium supplementation
You may need to try a few brands of calcium before you find the one right for you. Some can cause gas, constipation and bloating, especially calcium carbonate.
– Some forms of iron supplementation (often prescribed for anemia)
When iron is not fully absorbed, it travels to the colon and can cause constipation. Taking a stool softener such as Colace can often help.
Types of constipation among elderly
Constipation comes in many forms and it’s important to understand what kind of constipation an elderly person has. This will help doctors or caretakers address the root cause.
Normal transit constipation
This is the most common type of constipation and occurs when stool is difficult to pass.
Slow-transit constipation
Most common in women this refers to infrequent bowel movements, no urgency to defecate, and straining to pass the bowel movement when necessary
Pelvic floor dysfunction
If there is a problem in the muscles of the pelvic floor, patients may experience the feeling that they need to pass a bowel movement or have yet to complete it even though they have.
Diagnosis of constipation in elderly
In order to diagnose constipation, a doctor will take a medical history and it’s important patients are honest about signs of constipation. A physician will be able to assess if the constipation is caused by medication, prolonged inactivity, and changes in diet and fluid intake.
If your constipation started suddenly, has only become worse, your stool contains blood, or you fall into one of these categories, it’s important to alert your physician:
– Unexplained weight loss
– Fever
– Nausea
– Vomiting
– Loss of appetite
– Family history of inflammatory bowel disease or colon cancer
In adults over age 50, evaluations will be more in-depth and doctors may want to test for indications of colon and rectal cancers.
Constipation From Other Health Conditions
When the body isn’t functioning at its prime, meaning you are sick or injured, it can affect your internal organs and the way you process food.
These conditions may also count constipation among their side effects:
– heart diseases like heart failure
– Diabetes mellitus
– Hypothyroidism (underactive thyroid)
– Hypercalcaemia (increased blood calcium)
– Hypokalaemia (low blood potassium)
– Hypomagnesaemia (increased blood magnesium)
– Hyperparathyroidism (overactive parathyroid glands)
– Specific muscle and nerve disorders, such as dermatomyositis, systemic sclerosis, autonomic neuropathy, Parkinson’s disease, spinal cord lesions, dementia. and depression.
– Diseases of the gastrointestinal system, including anal fissures, diverticular disease, strictures, irritable bowel disease, rectal prolapse, volvulus, megacolon, etc.
Management of constipation in elderly
There are many ways to manage constipation in the elderly. Usually, one of the first challenges is to open up lines of communication so they feel comfortable sharing. It’s critical to remind patients that bodily functions are something we all have in common and ignoring the signs of illness can have negative consequences.
The primary aim when it comes to the management of chronic constipation in the elderly is to restore normal bowel habits and ensure passage of soft, well-formed stool.
It’s also critical to ensure they’re bowel passing movements at least three times a week without the need for straining, and to improve the quality of life with minimal side effects.
Lifestyle changes
Lifestyle changes may be a mental challenge, but they can improve your body’s strength, resilience, and ability to fight disease and ward off signs of illness , such as constipation.
These may include:
– Physical activities (this can be as simple as walking, if they are mobile)
– Improved eating habits
– Getting proper fluids
– Eating a diet high in fiber
– Reducing the consumption of constipating beverages such as alcohol, coffee, or tea
Medications
While medications are an option, it’s always best to try some lifestyle changes before you commit to taking things like laxatives and enemas since these can interfere with the digestive system and cause other side effects.If you’re a caregiver, it’s critical to know if a patient’s doctor knows about any constipation, medications, or other management plans necessary to treat constipation in the elderly.