What Causes Constipation in Older Adults?
Older adults are five times more likely than younger adults to report
problems with constipation. Poor diet, insufficient intake of fluids, lack of
exercise, the use of certain drugs to treat other conditions and poor bowel
habits can result in constipation. Experts agree, however, that too often older
people become overly concerned with having a bowel movement and that
constipation is frequently an imaginary ailment.
Diet and dietary habits can play a role in developing constipation. Lack of
interest in eating - a problem common to many single or widowed older people -
may lead to heavy use of convenience foods, which tend to be low in fiber. In
addition, loss of teeth may force older people to choose soft, processed foods,
which also tend to be low in fiber.
Older people sometimes cut back on fluids, especially if they are not eating
regular or balanced meals. Water and other fluids add bulk to stools, making
bowel movements softer and easier to pass.
Prolonged bedrest, for example, after an accident or during an illness, and
lack of exercise may contribute to constipation. Also, drugs prescribed for
other conditions, such as antidepressants, antacids containing aluminum or
calcium, antihistamines, diuretics, and antiparkinsonism drugs, can produce
constipation in some people.
The preoccupation with bowel movements sometimes leads older people to depend
heavily on laxatives, which can be habit-forming. The bowel begins to rely on
laxatives to bring on bowel movements, and over time, the natural mechanisms
fail to work without the help of drugs. Habitual use of enemas also can lead to
a loss of normal function.
What Diagnostic Tests Can Help Determine the Causes
of Constipation?
Constipation may be caused by abnormalities or obstructions of the digestive
system in some people. A doctor can perform tests to determine if constipation
is the symptom of an underlying disorder.
In addition to routine blood, urine, and stool tests, a sigmoidoscopy may
help detect problems in the rectum and lower colon. In this procedure, which can
be done in the doctor’s office, the doctor inserts a flexible, lighted
instrument through the anus to examine the rectum and lower intestine. The
doctor may perform a colonoscopy to inspect the entire colon. In colonoscopy, an
instrument similar to the sigmoidoscopy, but longer and able to follow the
twists and turns of the entire large intestine, is used. A barium enema X-ray
will provide similar information. If bleeding is present, a double-contrast
barium enema is preferred.
Other highly specialized techniques are available for measuring pressures and
movements within the colon and its sphincter muscles, but these are used only in
unusual cases.
Is Constipation Serious?
Although it may be extremely bothersome, constipation itself usually is not
serious. However, it may signal and be the only noticeable symptom of a serious
underlying disorder such as cancer. Constipation can lead to complications, such
as hemorrhoids caused by extreme straining or fissures caused by the hard stool
stretching the sphincters. Bleeding can occur for either of these reasons and
appears as bright red streaks on the surface of the stool. Fissures may be quite
painful and can aggravate the constipation that originally caused them. Fecal
impactions tend to occur in very young children and in older adults and may be
accompanied by a loss of control of stool, with liquid stool flowing around the
hard impaction.
Occasionally, straining causes a small amount of intestinal lining to push
out from the rectal opening. This condition is known as rectal prolapse and may
lead to secretion of mucus that may stain underpants. In children, mucus may be
a feature of cystic fibrosis.
When Is Medical Attention Needed?
The doctor should be notified when symptoms are severe, last longer than
three weeks, are disabling, or when any of the complications listed above occur.
The doctor should be informed whenever a significant and prolonged change of
usual bowel habits occurs.
The symptoms of constipation are key to helping the physician determine a
diagnosis and treatment. They include: infrequency of bowel movements,
straining, pain, or unsatisfied defecation. In addition, a full record of
prescription and over-the-counter medications should be provided to the
physician.
What Is The Treatment For Constipation?
The first step in treating constipation is to understand that normal
frequency varies widely, from three bowel movements a day to three a week. Each
person must determine what is normal to avoid becoming dependent on laxatives.
For most people, dietary and lifestyle improvements can lessen the chances of
constipation. A well-balanced diet that includes fiber-rich foods, such as
unprocessed bran, whole-grain bread, and fresh fruits and vegetables, is
recommended. Drinking plenty of fluids and exercising regularly will help to
stimulate intestinal activity. Special exercises may be necessary to tone up
abdominal muscles after pregnancy or whenever abdominal muscles are lax.
Bowel habits are also important. Sufficient time should be set aside to allow
for undisturbed visits to the bathroom. In addition, the urge to have a bowel
movement should not be ignored.
If an underlying disorder is causing constipation, treatment will be directed
toward the specific cause. For example, if an underactive thyroid is causing
constipation, the doctor may prescribe thyroid hormone replacement therapy.
In most cases, laxatives should be the last resort and taken only under a
doctor’s supervision. A doctor is best qualified to determine when a laxative is
needed and which type is best. There are various types of oral laxatives, and
they work in different ways.
Above all, it is necessary to recognize that a successful treatment program
requires persistent effort and time. Constipation does not occur overnight, and
it is not reasonable to expect that constipation can be relieved overnight.
The frequency of bowel movements among healthy people varies from three
movements a day to three a week. Individuals must determine what is normal. As a
rule, constipation should be suspected if more than three days pass between
bowel movements or if there is difficulty or pain when passing a hardened stool.
Most people experience occasional short bouts of constipation, but if a laxative
is necessary for longer than three weeks, check with a doctor.
Doctors agree that prevention is the best approach to constipation. While
there is no way to ensure never experiencing constipation, the following
guidelines should help:
