Managing constipation in older adults

By Dibya Prakash

Have you ever experienced constipation? Do you remember the symptoms that came with it?

These symptoms, typically associated with constipation, include a bloated stomach, stomach pain or cramps, difficulty evacuating, a feeling of fullness in the lower abdomen, lethargy, irritability and a sensation of dullness or even moderate pain in the head.

You can be a victim of one of these or even more, depending on the intensity of your condition. But one thing is certain; you will be plagued by unease and discomfort.

Constipation can occur at any age but is particularly common among older adults. This condition can lead to serious complications due to reduced intestinal and colon motility, poor abdominal muscle tone, decreased dietary fibre intake, and low physical activity associated with ageing.

You can consider yourself to be suffering from this malady when there are three or fewer bowel movements in a week or the inability to completely empty your bowels. Some people also consider themselves constipated if they need to strain to have a bowel movement. Constipation occurs occasionally for everyone, but when it becomes frequent, it can be problematic.

The word ‘problematic’ may seem stressful, but the reason why frequent constipation is bad is because when stool remains in the large intestine or colon for too long, it can become hard, dry, and more difficult to pass. Approximately 16 percent of adults experience chronic constipation. This percentage rises to about one-third of adults over the age of 60 and about half of all adults living in hospitals or nursing homes.

Delving further to know about this ailment which isn’t really considered one yet cannot be ignored either, we see that there are two main types of constipation:

1. Atonic Constipation: Also known as “Lazy Bowel,” this occurs due to a loss of muscle tone resulting in weak peristalsis. Causes include:

• Lack of fluids, roughage, and potassium
• Vitamin B Complex deficiency
• Irregular defecation habits and poor personal hygiene
• Excessive use of purgatives or enemas
• Sedentary lifestyle or lack of exercise

2. Obstructive Constipation: This type usually results from an obstruction in the colon, such as cancer or other conditions causing inflammation or narrowing of the lumen, making it difficult to expel stool.

The most common causes of constipation include a lack of fibre in the diet, insufficient fluid intake, lack of exercise, and a loss of tone in the intestinal muscles. Additionally, chronic overuse of laxatives, nervous strain, and worry are also common contributing factors.

Management of Constipation

By now, you must have realized that proper dietary and lifestyle management can significantly help maintain normal bowel movements. Medical interventions are necessary only when constipation is due to structural or functional changes in the gastrointestinal tract.

The primary treatment for constipation focuses on diet, with a strong emphasis on dietary fibre and fluid intake. Effective management involves developing regular habits through a bowel training program and establishing healthy routines, such as regular meals, scheduled elimination times, adequate fibre and fluid intake, and sufficient exercise.

Sources of dietary fibre include whole grain cereals, legumes, whole pulses, leafy vegetables, vegetables such as peas, beans, and okra, fruits like guava, apples, and citrus fruits, as well as nuts and oilseeds like flaxseeds and fenugreek seeds.

Fibre stimulates peristalsis. There is great enthusiasm to encourage the consumption of fibre containing food but any increase should be gradual otherwise bowel discomfort, distension and flatulence will be inevitably caused. While rough fibre, bran and mature vegetables are not advised for the aged, the fibre of tender vegetables, fruits will make easier the passage of the food mass down the intestinal tract for them. This can also be relieved through use of inputs like sprouting, fermentation, proper distribution of high fibre foods throughout the day and adequate fluids.

The fluid intake should be at least 2 litres daily. This includes fluid and beverages besides water. The intake of lemon juice, coconut water, vegetable soups, watery dal and lassi may have an added benefit of adding vital nutrients like potassium which improve the muscle tone.

You also need to try avoiding refined foods like pasta, refined cereals like maida, suji, baked products, pizza, patties, biscuits, deep-fried foods, pureed fruits and vegetables, banana, mango etc.

Further, when changes in diet and activity patterns do not improve constipation, necessary clinical evaluation and medication are warranted. However, since ‘a stitch in time, saves nine’, it’s always better to ward off the need to expose yourself to medication. What can easily be controlled through dietary adjustments and firm resolutions need not be traded with syrups or tablets!

Read also:
Adapting to changing nutritional needs as we age
Aging gracefully: Celebrating life’s later chapters