Safely Managing Constipation In The Elderly

Guidance on managing constipation in older adultsConstipation can affect anyone, but older adults may be more susceptible to this for a number of reasons. Here, we are taking a look at why this is, the symptoms and signs to watch out for, the possible underlying reasons, when to seek medical advice, complications of constipation, how it can be treated and managed, how to prevent it from happening, and how caregivers can help to support older adults who experience constipation regularly.At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about constipation in older people, we can help. 

Why are older adults more susceptible to constipation? 

Older adults tend to suffer from constipation more than younger people do, and women often experience this more than men. Research finds that 30-40% of older people suffer from chronic constipation, and here are some of the reasons for this: 

• As we age, our digestive system tends to naturally slow down, which makes it harder for the colon to move waste efficiently
• Many older adults take medications such as painkillers, antidepressants and blood pressure medications to manage common conditions, and some of these can contribute to constipation
• Older adults tend to have reduced mobility and physical activity in their day, which can impact digestion and cause constipation 
• Older adults are more susceptible to dehydration due to chronic medical conditions, reduced kidney function and loss of appetite, and this can cause constipation 
• If older adults are not eating enough fibre as part of their daily diet, this could lead to constipation 
• Age-related medical conditions, such as diabetes or Parkinson’s disease, can affect bowel function and lead to constipation 

What complications can occur from chronic constipation? 

Faecal impaction causes hard stool to get stuck in the intestines, and several complications can occur from straining to alleviate this chronic constipation. These include haemorrhoids, which are swollen blood vessels that occur due to straining, anal fissures, which are tears in the skin, or rectal prolapse, which is when the rectum protrudes from the anus. Older adults may find symptoms of constipation lead to excessive pain and discomfort, and could cause further health issues such as infections. For those who may have reduced mobility to manage constipation in day-to-day life, it is extremely important for caregivers to help with this issue even if it seems short-term, to ensure further complications do not arise. 

When should older people see a doctor about constipation? 

Older adults should see a doctor about constipation issues if:

• Symptoms persist for more than three weeks
• There is severe pain or discomfort during bowel movements
• There is blood in their stool
• If constipation is accompanied by unexplained weight loss
• If constipation is accompanied by vomiting or a fever 

If there are signs of a possible blockage (such as an inability to pass gas), then immediate medical attention is needed. Also, if you have tried taking over-the-counter remedies such as laxatives, or if constipation becomes a recurring issue, seek medical advice to rule out any underlying conditions, and so your doctor can do the appropriate tests to ensure everything is working as it should be. These may include a physical examination, a review of your medical history, or anything else that must be done to determine the underlying cause. Speaking to a doctor can be difficult, as any issues with the bowels are often seen as embarrassing or shameful. This is far from the case, and your doctor will want to know if you are experiencing any constipation issues so they can check there is no underlying problem. Remember, they are used to discussing bodily functions like this, so never feel you need to be embarrassed by any symptoms you have.

What treatment options are there for constipation? 

There are several treatment options to help tackle constipation, and many can be done at home alone or with the assistance of a caregiver. If there is an underlying medical condition thought to be the cause, this may be treated separately. Similarly, if a specific medication is the culprit, your doctor may adjust your dosage of this or switch to a different kind. If none of these issues are behind the constipation, other treatment options may include:

Lifestyle Changes

Often the first things your doctor will likely recommend are certain lifestyle changes that usually relieve symptoms and the discomfort of constipation. These include increasing dietary fibre, which should be done gradually to avoid bloating and discomfort. Fibre intake can be increased through eating more fruits, vegetables and whole grains, with high-fibre foods, such as prunes, oats and beans being particularly effective. You can read more about the recommended amount of fibre in our guide to the best supplements and vitamins for older adults. If constipation has been present for a few days laxatives like Senna or Laxido will often be prescribed alongside these lifestyle changes. Also, drinking plenty of water can help to improve bowel regularity. Dehydration is common in older adults, so this may be an important change to make which can be achieved through drinking more liquids, eating more liquid-based foods (like soups or smoothies) and making drinks more accessible throughout the day so you remember to take them. You can also try to get more regular movement and exercise in your day to stimulate digestion. Even gentle exercise options such as walking or daily stretches can help with this, and you can find some tips in our guide to fitness and exercise for older adults.MedicationsOver-the-counter medications known as laxatives can help to manage constipation, and these could be stool softeners or fibre supplements. They should only be used on a short-term basis, and long-term use should be avoided without consulting a doctor. If you do see a doctor about constipation, they may recommend prescription medications that can help with chronic constipation and will be safer to use on a long-term basis.Other Options In cases where there is significant constipation, treatments such as enemas may be required in order to tackle faecal impaction, and in very severe cases where there could be further medical issues, surgery may be recommended to repair or remove parts of the colon that no longer function and cause chronic constipation.

How can older adults prevent constipation? 

Adopting healthy lifestyle habits usually helps to avoid digestive issues like constipation. Increase your fibre intake by eating more fruits, vegetables and whole grains instead of highly processed foods to promote regular bowel movements, and make sure you stay hydrated by drinking plenty of water throughout the day. This is important in order to soften stool enough to have a normal bowel movement. In addition, get regular physical activity, even from simply walking, to stimulate digestion and reduce the risk of constipation. It may also help to establish a consistent bathroom routine, and never ignore an urge to go if you have one. 

How can caregivers help older adults to manage constipation?

There are a number of ways caregivers can stay on top of this issue to help older adults manage constipation in everyday life. These include:

• Encouraging healthy dietary habits, such as increasing fibre intake through fruits, vegetables and whole grains
• Ensuring they drink plenty of water throughout the day
• Promoting regular physical activity to improve bowel function
• Reminding them to follow a consistent bathroom routine and avoid delaying bowel movements
• Monitoring for signs of discomfort or changes in bowel habits
• Assisting with any prescribed treatments like stool softeners or laxatives
• Encouraging them to try techniques to alleviate any anxiety around bathroom issues 
• Providing necessary emotional support for an older adult who may be in pain, uncomfortable, and embarrassed

If you are living with chronic constipation yourself, or you are caring for someone with chronic constipation, it is important to remain vigilant and look out for the early signs of constipation so you can take the appropriate steps to alleviate this before it becomes a worse problem. If you have any concerns about constipation in an older adult, speak to their GP for advice and treatments, and remember you can seek the assistance of a home carer to help manage their symptoms or any treatments they are recommended. Our Care Professionals are specially trained to help with issues such as these, and can provide encouragement for lifestyle changes, adherence to medication, and more. Home Instead’s team of Care Professionals are trained to the highest clinical standards and can work alongside your own doctors and health teams to ensure you receive the best care at home. Whether you require hourly care for a few hours a week, a couple of hours daily, or 24-hour live-in care to support your needs, we can help provide the bespoke, person-centred care you need. Reach out to the Home Instead team to discuss your needs and allow us to create a personalised package to support you.