Seasoned caregivers are no strangers to their elderly loved ones’ many digestive issues. From diarrhea to constipation and C. difficile 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 a great deal of discomfort and anxiety. Although most people prefer not to talk about their bowels, if this issue is left untreated over the long term, 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, English provides a wealth of insight and information about this 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 a symptom as well. A person experiencing constipation will often complain of abdominal discomfort and a feeling of fullness in or incomplete evacuation of the bowel.

According to English, 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,” notes English, “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,” English emphasizes. “Many elders subscribe to the myth that one should defecate at least once every day, but there is no such magic number or a prescribed schedule that people should aim for.”

English says that, “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, English advises making a doctor’s appointment.

Common Causes of Constipation

A person’s lifestyle plays a huge role in sluggish digestion. “Unfortunately for seniors, many of these contributing lifestyle factors are the norm,” English points out. “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,” notes English. 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, nerves and muscles around the colon can interfere with the ability to have regular bowel movements, too. “Infrequent elimination can be caused by hormone imbalances due to diabetes and thyroid issues, neurological problems associated with Parkinson’s disease, stroke, multiple sclerosis (MS), and issues with pelvic floor muscles,” English warns.

How to Get Relief

Most health care practitioners prefer to treat constipation more conservatively at first in the hopes the issue will resolve 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,” advises English. “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 to get things moving.”

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. These over-the-counter medications are intended to help the bowel move stool along and are typically the go-to remedy for constipated individuals. However, 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,’ ” English explains. “When this happens, the bowel is no longer able to pass stool without the use of laxative medications. More and more of the medication will be necessary for spurring any sort of movement, which can be difficult to reverse. 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 to Seek Medical Attention

It’s important to seek medical attention if constipation is persistent and not resolving. Chronic constipation is the term used when symptoms are present for three weeks or longer. When a person is chronically constipated, the muscles in the bowel are affected, making it harder for them to do their job. According to English, it is very difficult to then restore normal function.

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Complications of Constipation

If left untreated, constipation can lead to painful and sometimes embarrassing medical situations, some of which can be very serious.

Hemorrhoids and Anal Fissures

“The intense straining that often accompanies constipation can cause damage to vascular structures or skin in the anal canal,” English says. “These can be internal or external and typically present with light bleeding during BMs, itching, swelling and pain.” These injuries can become serious but often heal within a few days.

Fecal Impaction

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. “Not only can this can be a medical emergency, but it is also painful and uncomfortable for the person experiencing it,” warns English. “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. English points out that symptoms can become severe very quickly, 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
  • Pain
  • Nausea
  • Vomiting
  • Headaches
  • 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 constipation is at risk of impaction, and 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,” English explains. “A digital rectal examination may also be performed 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 Impaction Treated?

Laxatives are frequently one of the first choices for treatment of fecal impaction. However, English advises 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 treatments works, 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,” describes English. This procedure can be quite uncomfortable and is usually done without any anesthesia, although a mild sedative may be used. English warns that manual disimpaction should only be done by a trained medical professional due to the risk of perforation, vasovagal response (a 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 of the blockage 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,” urges English. “In this case, prevention comes in the form of proper diet (including lots of fiber and water), regular exercise and paying attention to personal ‘normal’ bowel functions.”