If you suffer from constipation, you've got plenty of company: About 24 to 50 percent of older adults regularly experience the condition. While it's not a subject that most people feel comfortable talking about, persistent or chronic constipation is definitely something to discuss with your doctor.
Unrelieved constipation can lead to fecal impactionwhen hard, dry stool becomes stuck in the rectumthat is associated with suppressed appetite, pain, nausea and functional decline. Straining during a bowel movement can cause hemorrhoids, anal tears or rectal prolapse (when the intestinal lining pushes out of the rectal opening); trigger a fainting episode; or restrict blood flow to the heart or brain.
Constipation refers to difficulty passing stool, an inability to have a complete bowel movement or a diminished frequency of bowel movements to fewer than three a week. Normal stool frequency can be any where between three movements a day and three movements a week.
The likelihood of constipation rises as you age. Many experts suspect that decreased activity and a diet low in fiber and fluids are to blame. Health conditions like diabetes, colon cancer, diverticulosis, irritable bowel syndrome and depression can also cause constipation. So can drugs such as iron supplements, antacids, antihistamines, opioids, diuretics, antidepressants and anti-Parkinson medicine.
What you can do
Your first step toward easing constipation is to try self-help strategies. Try these suggestions for starters:
- Practice better bathroom habits. Don't ignore the urge to go. Give yourself adequate toilet time and avoid rushing or straining. When seated, your knees should be level with or above your hips. Place your feet on a small step stool to bring your knees higher, if necessary.
- Avoid preoccupation with bowel movements. Anticipating a daily bowel movement causes some people to believe they're constipated when they’re not. "Pseudo-constipation" can lead to overuse of laxatives and enemas. Habitual laxative use can cause the colon to lose the ability to move stool on its own.
- Boost your fiber intake. Increase your intake of fresh fruits, vegetables, prune juice, whole grains and legumes, but do so gradually to prevent bloating and gas. Aim for 20 to 25 grams of fiber a day. If you're bedridden, increasing fiber intake isn’t advised, since it can put you at risk for fecal impaction.
- Drink more fluids. Adding fluids to your diet adds water and bulk to your stool.
- Exercise regularly. A daily walk can help get things moving.
Other go-to remedies
Do you turn to a laxative when you're constipated? You should do so only when diet and lifestyle changes don't work and after checking with your doctor. A team of researchers recently reviewed studies on constipation treatments in older adults, published online in the Canadian Medical Association Journal. They concluded that, among over-the-counter and prescription products, osmotic laxatives offer the best relief for older adults. Here's some of what the researchers found:
- Laxatives. Osmotic laxatives containing polyethylene glycol (MiraLax) or lactulose (Cholac, Enulose) offer the best relief by far. Bulk-forming laxatives containing psyllium (Metamucil, Fiberall) may help some people. The researchers gave low marks to stimulant laxatives containing bisacodyl (Correctol, Dulcolax) or senna (Ex-Lax, Senokot), which haven't been shown to be effective in studies. Most laxatives cause side effects such as gas, bloating, diarrhea and abdominal pain.
- Stool softeners. Inconclusive research shows stool softeners (Colace, Surfak) to have limited effect.
- Suppositories and enemas. Their effectiveness is questionable, but generally, suppositories shouldn't be used for everyday constipation. Enemas should be administered by a clinician only if there's a risk of fecal impaction.
- Prescription drugs. Linzess (linaclotide) is prescribed for adults who don't respond to standard treatment, and the laxative Amitiza (lubiprostone) for severe constipation. The researchers found both drugs to be effective options.
In January 2014, the U.S. Food and Drug Administration (FDA) issued a warning against exceeding the recommended dosage of over-the-counter (OTC) oral solutions and enemas containing sodium phosphate. In rare cases, taking a larger-than-recommended single dose of these medications, or taking more than one dose in a day can lead to severe kidney or heart damage. According to the FDA, OTC constipation remedies should only be used as directed. Children, adults over the age of 55, people who are dehydrated, and those who have kidney or bowel disease or are taking certain other medications (e.g., NSAIDs, diuretics, ACE inhibitors, ARBs) are at higher risk for these serious complications.
When to see the doctor
If constipation comes on suddenly; is accompanied by severe symptoms such as abdominal pain, weight loss, fever or weakness; or persists longer than three weeks, it’s time to see your doctor.
Christina Y. Ha, MD, Assistant Professor, Division of Gastroenterology and Hepatology, Johns Hopkins Medicine
Many strategies we use to ease constipation in older adults have no supporting evidence from well-designed clinical trials; however, that doesn't mean certain remedies don't work. In some cases, not enough quality research has been done to establish a treatment's effectiveness. If you use a laxative, avoid long-term reliance on the product unless directed by your doctor.
Prolonged use can lead to electrolyte imbalance, especially for people with diabetes or kidney disease or interfere with other drugs you're taking. Also, as persistent constipation may be a harbinger for other conditions, work with your medical team to ensure a thorough evaluation has been performed and to formulate the optimal treatment plan.
Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50; Updated by Remedy Health Media