Seasoned caregivers are no strangers to digestive issues of all kinds affecting their loved ones. From diarrhea to constipation and c. diff to IBS, many conditions can plague the aging digestive system. Our metabolisms slow naturally as we age, which can affect digestion, but when things come to a screeching halt, it can cause discomfort and anxiety. Although most people prefer not to talk about their bowels, if this issue does not resolve on its own or worsens, it can lead to serious health problems like impaction, anal fissures and bowel incontinence.
“Constipation is a very common health concern affecting people of all ages, but particularly the elderly,” says Kim English, BScN, MN and professor at the Trent/Fleming School of Nursing in Peterborough, Ontario, Canada. “There is a stereotype of older people focusing solely on the function of their bowels. That may not be a bad thing, but the reality is that we all experience episodes of constipation at some point of our lives.”
According to the National Institutes of Health, constipation affects approximately 42 million Americans. Below, in Kim’s words, is a trove of insight and information about this important problem that can turn into a major health event, especially for seniors.
What Is Constipation?
The medical definition of constipation is when a person has less than 3 bowel movements (BMs) a week, and those movements consist of hard, dry stools that are difficult to pass. Frequent straining during BMs is also a sign of constipation. A person experiencing constipation will often complain of abdominal discomfort and a feeling of fullness in or incomplete evacuation of the bowel.
Constipation is generally considered a symptom of another problem, so it is important to actively seek out the root cause, especially if it is recurrent or long lasting. It can be caused by bowel diseases such as diverticulitis, irritable bowel syndrome (IBS), or lack of fiber and water in the diet. It can also be caused by a number of different medications, which ironically includes an overuse of laxatives!
How Often Should You "Go?"
Every person’s body, metabolism and eating habits are different, therefore there is no single definition of normalcy when it comes to the frequency of bowel movements. Many elders subscribe to the myth that one should defecate at least once every day, but there is no such magic number of BMs or a prescribed schedule that people should aim for.
Instead, “normality” falls within a range of no more than three movements a day and no less than three movements each week. Falling just outside this range is not necessarily a cause for concern unless other troubling symptoms are present. Each person knows their own body best and what is considered normal for them. If this schedule changes and is accompanied by discomfort or other warning signs, it’s an indicator that something is amiss and it may be time to schedule a doctor’s appointment.
A person’s lifestyle plays a huge role in sluggish digestion. Unfortunately for seniors, many of these contributing lifestyle factors are the norm. For example, older individuals experience a weaker “thirst mechanism” and often suffer from dehydration without even knowing it. Limited physical activity is also common in seniors with mobility issues, disabilities and those who are bedridden or require prolonged bed rest.
Lastly, individuals over age 65 commonly take multiple prescription medications for numerous chronic conditions. Narcotic pain medications (opioids) are notorious for interfering with digestion, but are often prescribed to seniors with conditions like arthritis, cancer, neuropathy and fibromyalgia as well as following an injury, surgery or infection. Other medications and supplements such as antidepressants, anticonvulsants, antihistamines, antacids, diuretics, calcium channel blockers and iron supplements can cause digestive issues as well.
Any one of the aforementioned causes can contribute to irregularity, but for a senior who does not consume much fluid, rarely leaves their home due to limited mobility, and takes pain medications for osteoarthritis and a calcium channel blocker for high blood pressure, constipation is inevitable.
Conditions that affect hormones and nerves and muscles around the colon can also interfere with the ability to have regular bowel movements. Infrequent elimination can be caused by hormone imbalances due to Diabetes and thyroid issues, neurological problems associated with Parkinson’s disease, stroke, and multiple sclerosis (MS), and issues with pelvic floor muscles.
How to Get Relief
Most health care practitioners prefer to treat concerns such as constipation more conservatively at first in the hopes the issue will resolve itself on its own. An initial first step would be encouraging a person to incorporate more fiber in their diet and increase their fluid intake—especially water.
Exercise is also an important component of healthy digestion, as it encourages movement of the muscles in the bowel. A physical activity regimen doesn’t have to be strenuous, last an hour each day or involve going to the gym, but taking a daily walk or performing some chair exercises while watching TV can do wonders.
Health care practitioners will want to address the symptoms of any underlying diseases as well. Most importantly, they will be looking at how many laxatives a person uses and how frequently they take them. Laxatives are intended to help the bowel move stool along, and these over-the-counter medications are typically the go-to remedy for constipated individuals. Stool softeners are often preferred over stimulant laxatives and osmotic laxatives, which can cause adverse effects like electrolyte imbalances and lazy bowel syndrome.
Using too many stimulant laxatives too often actually slows natural movements down, making the bowel “lazy.” When this happens, the bowel is no longer able to pass stool without the use of laxative medications. The person will need to take more and more of the medication in order to have any sort of movement. This condition can be difficult to reverse, as the bowel consists of many muscles that play a role in evacuation, but these cannot be strengthened in the same manner as other muscles in the body.
When Should You Seek Medical Attention?
It’s important to seek medical attention if constipation is persistent and not resolving. Chronic constipation is the term used when a person experiences symptoms for three weeks or longer. When a person is chronically constipated, the muscles in the bowel are affected, making it harder to do their job. It is very difficult to then restore this function.
Complications of Constipation
When left untreated, constipation can lead to painful and sometimes embarrassing medical situations, some of which can be very serious, including anal fissures and rectal prolapse.
Hemorrhoids and Anal Fissures
The intense straining that often accompanies constipation can cause damage to vascular structures or skin in the anal canal. These can be internal or external and typically present with light bleeding during BMs, itching, swelling and pain. These can become serious, but often heal within a few days.
One especially concerning outcome of untreated constipation is fecal impaction. Impaction can become a medical emergency, occurring when the bowel becomes completely blocked with a solid, immobile mass of feces. This mass becomes hard and blocks off the bowel. Not only can this can be a medical emergency, but it is also painful and uncomfortable for the person experiencing it. The large intestine becomes blocked, and the problem just keeps getting worse.
The first sign of fecal impaction may be the lack of a bowel movement for an extended period of time. Symptoms of can proceed quickly to being very severe, so it is important to keep an eye out for these signs if your loved one is prone to chronic digestive issues.
- Abdominal discomfort and bloating
- Loss of appetite
- Weight loss
- Some people may also experience some leakage of liquid stool (encopresis) that is trying to get past the area of blockage.
How Is Fecal Impaction Diagnosed?
Anyone who has persistent symptoms of constipation is at risk of impaction. It is important to seek medical attention for chronic symptoms. A health care provider will perform an abdominal assessment and will likely be able to feel the mass. They may also perform a digital rectal examination to determine the presence of stool and/or a blockage in the lower part of the colon. They may then perform other diagnostic tests, such as x-rays, to confirm the nature of the blockage.
How Is It Treated?
Laxatives are frequently one of the first choices for treatment of fecal impaction. However, these must be administered very carefully under the direction and supervision of healthcare providers, otherwise they may cause more problems. Enemas and water irrigation enemas may also be used, again with caution.
If none of these treatment options work, then the only remaining option may be manual removal. Manual disimpaction involves a health care provider removing the fecal matter using lubricant and a gloved finger. This procedure can be quite uncomfortable and is usually done without any anesthesia, although a mild sedative may be used. This procedure should only be done by a trained medical professional due to the risk of perforation, vasovagal response (sudden drop in heart rate and blood pressure also known as fainting) and bleeding.
In very severe cases where the above options are not successful, surgical removal may be necessary.
Constipation and fecal impaction can be serious health issues. The best way to maintain bowel health is through prevention. It is easier to prevent digestive issues than treat them after the fact. In this case, prevention comes in the form of proper diet (including lots of fiber and water), exercise and paying attention to personal “normal” bowel functions!