older woman with tea cup As you get older, you may begin to worry about things you never gave much thought to in the past: retirement savings, your will, regular bowel movements. Bowel movements?

Older people, it seems, can become preoccupied with having a daily bowel movement. Concerns about regularity are so prevalent, in fact, that many older adults end up abusing laxatives. Older people are more likely to become constipated. As you age, your metabolism slows, your teeth get weaker, your thirst slackens, and you may feel less able (or motivated) to incorporate exercise into your life. All of these changes contribute to constipation.

But real constipation is still not as common as you might think. And, if you do suffer from constipation, a few lifestyle changes could alleviate the problem, making laxatives unnecessary.

Is It Really Constipation?

Many older people think that they are constipated if they do not have one bowel movement every day. However, there is no right number of daily or weekly bowel movements. Two bowel movements per week might be normal for you, as might three bowel movements per day. You might also have naturally firmer or looser stools than others.

Constipation is defined as the passage of small amounts of hard, dry, bowel movements, usually fewer than three times per week. These bowel movements are often difficult and painful. People who are constipated often feel bloated, uncomfortable, and sluggish.

To determine if you might be constipated, answer the following questions:

  • Do you often have fewer than three bowel movements each week?
  • Do you often have a hard time passing stools?
  • Is there pain when you pass stools?
  • Are there other problems, such as bleeding?

If you answered “yes” to more than one of these questions, you may have constipation, and should talk to your doctor.

What Causes Constipation?

Constipation may be caused by a number of things, several of which are easy to reverse.

Diet

The most common cause of constipation is a diet low in fiber. The American Dietetic Association recommends eating 20 to 35 grams of fiber per day. Dietary fiber can be found in fruits, vegetables, and whole grains.

Getting enough fiber can be a particular problem for older people who are more likely to live alone and rely on prepared foods, which are often low in fiber. In addition, bad teeth may make it difficult to chew, leading older adults to opt for soft, processed foods, which also tend to be low in fiber.

Eating lots of high-fat foods, such as high-fat meats, dairy products, eggs, cheeses, and sweets, can also contribute to constipation.

Insufficient Liquids

Liquids add bulk to stools and make them softer and easier to pass.

Lack of Exercise

Doctors don’t know why lack of exercise leads to constipation, but the fact remains that people who are on bed rest following an accident or as the result of an illness often develop constipation.

Medications

Certain medications may cause constipation as a side effect. These include:

Misuse of Laxatives

Ironically, the misuse of laxatives can cause constipation. This is because, over time, laxatives can damage nerve cells in the colon, making it more difficult for the colon to contract naturally. Eventually, the colon begins to depend on laxatives to initiate bowel movements. Misuse of enemas can also interfere with normal bowel function for the same reason.

Ignoring the Urge to Have a Bowel Movement

Many people prefer to have bowel movements at home. However, if you ignore the urge to have a bowel movement too frequently, you may stop feeling the urge, which can lead to constipation.

Aging

Aging is itself a risk factor for constipation. As you get older, your metabolism slows down. This, in turn, reduces intestinal activity and muscle tone, which can lead to constipation.

Irritable Bowel Syndrome

Irritable bowel syndrome, also known as spastic colon, can cause alternating bouts of constipation and diarrhea. It is often accompanied by cramping, gas, and bloating. If you think you have this condition, talk with your doctor. There may be treatments that can help you.

Other Causes

The following diseases and conditions can also cause constipation. In some cases, it is a combination of the disease/disorder and the medications used to treat it that cause the constipation.

When Should You See a Doctor About Constipation?

If you have change in your bowel habits lasting more than a week or two, you should see your doctor. While the list above emphasizes the many conditions that can cause constipation, your doctor will likely focus on three diagnostic questions:

  • 1. Do you have cancer?

    Colorectal cancer is one of the most common cancers in older adults and can be cured if caught early enough. While it is probably better to detect cancer through screening before it causes constipation, many persons with bowel cancer who seek early care for constipation have an effective long term cure of their condition and become cancer survivors. All persons above 50 should have periodic screening for colon cancer, either with colonoscopy every 5-10 years or with yearly testing for blood in the stool.

  • 2. Do you have a problem with your thyroid?

    Underactive thyroid is quite common in older persons and can sometimes present with constipation. Your doctor will likely screen you for hypothyroidism using a blood test called the TSH.

  • 3. Do you have diabetes?

    In most older adults, diabetes causes no symptoms until it has been present for many years. By this time some problems due to damage of the nerves to the bowel may occur, and chief among these is constipation. While most persons with constipation do not have diabetes (or hypothyroidism or cancer), a simple blood test can detect the presence of diabetes and get helpful treatment underway.

Diagnosing Constipation

If your doctor suspects that you are constipated, he or she will most likely take a medical history and then perform a physical examination. This may include a digital rectal exam to evaluate the muscle tone of the anal sphincter (the muscle that closes off the anus) and to detect tenderness, obstruction, or blood. For this exam, your doctor inserts a gloved, lubricated finger into the anus to check for lumps or other abnormalities.

He or she may also perform blood or thyroid tests. If everything seems normal, your doctor will likely recommend changes in diet and exercise.

However, if there is blood in your stools, or you have experienced recent changes in bowel movements, or have recently lost weight, your doctor may recommend further tests. Also, because your risk of colorectal cancer increases as you get older, your doctor may perform the following tests to rule out cancer:

Barium Enema X-Ray

A barium enema is a rectal injection of barium given to coat the lining of the colon and rectum. Barium is a milky fluid that absorbs x-rays. It is given before x-rays are taken in order to create better images.

Sigmoidoscopy or Colonoscopy

A long, flexible tube with a light on the end is inserted through the anus, then into the rectum to view the rectum and lower colon (sigmoidoscopy) or the rectum and entire colon (colonoscopy). If the doctor sees something unusual, he or she can remove a small piece of tissue for biopsy. You will be given sedation before this procedure to help you relax.

Colorectal Transit Study

You'll swallow capsules containing particles that can be observed on an x-ray. While you follow a high-fiber diet, the movement of these particles is monitored via abdominal x-rays for three to seven days .

Anorectal Function Tests

Anorectal manometry tests anal sphincter muscle function. A catheter or air-filled balloon is inserted into the anus, then pulled back through the sphincter muscle while the physician measures muscle tone and contractions.

Defecography measures completeness of stool evacuation, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. For this test, your doctor will fill your rectum with a soft paste, which has a consistency that mimics stool. You will sit on a toilet inside an x-ray machine and will be asked to expel the solution. Your doctor will then examine x-rays taken during the procedure.

How Is Constipation Treated?

Treatment of constipation usually begins with a change in diet and exercise. Your doctor may also recommend limited use of laxatives. If an underlying condition is causing your constipation, you may undergo condition-specific treatment.

Diet

Eat at least 25 to 30 grams of dietary fiber per day. To accomplish this, incorporate plenty of high-fiber foods such as beans, whole grains, bran cereals, fresh fruits, dried fruits, and vegetables (asparagus, brussels sprouts, cabbage, and carrots are good choices) into your diet.

You may want to try adding small amounts of unprocessed bran (miller’s bran) to baked goods, cereal, or fruits. You may experience some bloating and gas for several weeks while your body gets used to this additional fiber. Increase your intake of fiber slowly and drink lots of fluids in order to decrease this type of discomfort.

Limit your intake of high-fat, low-fiber foods such as ice cream, cheese, meat, and processed foods.

Talk to your doctor or dietitian about food selection or preparation if you have particular concerns such as bad teeth.

Drink Plenty of Liquids

Try to consume at least 64 ounces (one quart) of liquids per day. Good choices are water, fruit and vegetables juices, and clear soups. Large quantities of milk can cause constipation in some people. (If you have heart, blood vessel, or kidney problems, check with your doctor before increasing your liquid intake.)

Exercise Regularly

Try to incorporate some form of exercise—walking is a good option—into your daily routine. If you have any health concerns, check with your doctor before starting an exercise program.

Laxatives

If diet and lifestyle changes have not improved your constipation, your physician may recommend limited treatment with laxatives. Your doctor will determine which type of laxative you should take and for how long. Different types of laxatives work in different ways:

  • Bulk-forming Laxatives—These laxatives, also known as fiber supplements, are generally considered to be the safest laxatives. However, they can interfere with the absorption of some medications. Bulk-forming laxatives work by absorbing water in the intestine and making the stool softer. Examples include Citrucel and Metamucil.
  • Stimulants—Stimulants work by causing rhythmic muscle contractions in the intestines. Some contain an ingredient called phenolphthalein. The Food and Drug Administration has proposed a ban on all over-the-counter laxatives containing phenolphthalein because it may increase a person’s risk for cancer. Most manufacturers have replaced or plan to replace phenolphthalein with a safer ingredient. Examples include Correctol and Dulcolax.
  • Stool Softeners—These provide moisture to the stool and prevent dehydration. Examples include Dialose and Surfak.
  • Lubricants—Lubricants grease the stool, enabling it to move easily through the intestine. Overuse of mineral oil, the most common lubricant, can lower your body’s ability to use vitamins A, D, E, and K.
  • Saline Laxatives—These draw water into the colon, allowing the stool to pass more easily. Examples of this option include Milk of Magnesia and Citrate.

Prevention

Follow these guidelines to reduce your chances of becoming constipated:

  • Eat a high fiber, low-fat diet.
  • Drink at least eight, 8-ounce glasses of liquids per day.
  • Exercise regularly.
  • Set aside time (after breakfast or dinner, for example) for undisturbed visits to the bathroom.
  • If you feel the urge to have a bowel movement, don’t delay.
  • If you experience a significant or prolonged change in bowel movements, visit your doctor.