Although not typically discussed, many adults suffer from constipation. If fact, chronic constipation is very common in adults 60 years and older and up to 50% of nursing home residents complain of symptoms. Constipation is when you feel like you are not able to have a complete bowel movement. Constipation can also cause hard stools, stomach pains, abdominal bloating, or swelling. It may be diagnosed by a healthcare provider if you have less than three bowel movements per week. According to the Clinics in Geriatric Medicine constipation results in 2.5 million physician visits and roughly 92,000 hospitalizations each year.
There are many factors that contribute to constipation. Medical diagnoses and medications are two big playing factors. Medical diagnoses that may contribute to higher risks of constipation include endocrine and metabolic disorders such as diabetes, hypothyroidism, hyperparathyroidism, and chronic renal disease. Electrolyte disturbances such as hypercalcemia, hypokalemia, and hypermagnesemia. And neurologic disorders such as Parkinson’s disease, multiple sclerosis, autonomic neuropathy, spinal cord lesions and dementia. Many medications may also have side effects of constipation. These may include analgesics (opiates, tramadol, NSAIDs), anticholinergic agents, anti-hypertensive medications (calcium channel blockers), antidepressants, antiparkinsonian drugs (dopaminergic agents), antacids, calcium supplements, bile acid binders, iron supplements, antihistamines, diuretics, antipsychotics, and anticonvulsants. With such a lengthy list of medications and diagnoses contributing to constipation there is no wonder why so many older adults suffer with symptoms.
There are numerous treatment methods to aid in constipation relief. Along with pharmaceuticals, lifestyle modifications, such as increased fluid intake, increased dietary fiber intake, and regular physical activity can make a difference. Additional fiber may help keep your bowels working regularly. Fiber intake should be increased slowly over several weeks to decrease adverse effects.
Dietary fiber is also known as roughage or bulk and includes the parts of plant foods that your body cannot digest or absorb. Fiber passes relatively intact through your stomach, small intestine, and colon and out of your body. Fiber is commonly classified as soluble, which dissolves in water, or insoluble, which does not dissolve. The daily recommendation for dietary fiber is 14 grams for every 1,000 calories, which is about 25 grams for women and 30 grams for men per day.
Soluble fiber is found in oats, peas, beans, apples, citrus fruits, carrots, barley, and psyllium. Soluble fiber dissolves in water to form a gel-like material. Good sources of insoluble fiber include whole-wheat flour, wheat bran, nuts, beans, and vegetables, such as cauliflower, green beans, and potatoes. Insoluble fiber promotes the movement of material through your digestive system and increases stool bulk. The amount of soluble and insoluble fiber varies in different plant foods. To receive the greatest health benefit, eat a wide variety of high-fiber foods.
In contrast, a low fiber eating pattern may contribute to constipation. Without eating enough fruits, vegetables, and whole grains it is nearly impossible to reach daily fiber goals. Foods low in dietary fiber include refined grains, such as white bread and rolls, white rice, spaghetti and other pastas, cereals and baked goods made from white flour. There are also a few foods that may worsen constipation. These include alcohol, processed grains, dairy products, fried foods, and red meat.
Consuming enough fluids with high fiber foods is crucial to prevent constipation. If you do not consume enough fluids, high fiber foods may actually increase your risk of constipation. Fluids help the fiber to work better and help keep your stool soft, which makes them easier to pass. Water is most important, but you can also include other unsweetened beverages throughout the day. The amount of fluid needed daily greatly depends on body size, weight, medications, and activity level. According to the Academy of Nutrition and Dietetics commonly used calculations for estimated fluid needs in the elderly include 1 mL of fluid per calorie (based on caloric needs) or urine output + 500mL/d (based on fluid balance). Prune juice may also be a beneficial fluid to help keep you regular. Some benefits have also been shown by starting the day with a warm beverage.
Physical activity is also helpful to keep your bowels moving regularly and aid in preventing constipation. Short, 10–15-minute walks after each meal can help keep your bowels working normally. The Physical Activity Guidelines for Americans recommends older adults to incorporates balance training, aerobic and muscle strengthening exercises.
Making smart food choices and adopting good habits can make a difference in alleviating constipation. Work with a healthcare team to find out if any medications or supplements could be contributing to constipation. Aim to reach daily fiber and fluid goals to prevent chronic constipation and the pains associated with it.
Anne Mounsey, MD; Meghan Raleigh, MD; and Anthony Wilson, MD, University of North Carolina, Chapel Hill, North Carolina. (2015) Management of Constipation in Older Adults, American Academy of Family Physicians Sep 15;92(6):500-504 https://www.aafp.org/afp/2015/0915/p500.html
Ernest P.Bouras, MD and Eric G.Tangalos, MD. (2009) Chronic Constipation in the Elderly Gastroenterology Clinics of North America, Volume 38, Issue 3, September 2009, Pages 463-480 https://pubmed.ncbi.nlm.nih.gov/19699408/