Infrequent bowel movements or difficulty passing stool is unfortunately a common concern for many older adults. Constipation is not an inevitable part of aging, but certain medications, decreased mobility, some health conditions and other physical changes can make it more likely in people over 65.

Chronic constipation can leave you feeling bloated and uncomfortable, it can interfere with daily tasks and activities and in some cases can lead to more serious health concerns. If you’re an older adult struggling with frequent constipation—or caring for a loved one who is—there are many ways to effectively manage symptoms and improve well-being and quality of life.

Constipation in Older Adults

Increasing constipation with age is usually a result of several causes and risk factors, including:

• Medications: Drugs commonly prescribed to seniors like antidepressants, antihistamines, pain killers, antacids and anti-Parkinson drugs can cause or worsen constipation.
• Limited Exercise: Low activity levels, especially for seniors recovering from an illness or surgery or for others with mobility issues, can cause digestion issues.
• Diet: Older adults who live alone may lose interest in cooking and eating and rely on convenience food that tends to be low in fibre. Loss of teeth and oral pain can also lead to less nourishing and processed food choices. And generally, many seniors do not incorporate enough sources of fibre in their diet.
• Dehydration: Seniors’ sense of thirst is often weakened and because of this many older adults are dehydrated. Water and other fluids add bulk to stools making them softer and easier to pass.
• Limited Exercise: Low activity levels, especially for seniors recovering from an illness or surgery or for others with mobility issues, can cause digestion issues.
• Medical Conditions: Diabetes, stroke, or neurological issues associated with Parkinson’s or Multiple Sclerosis can affect the muscles or nerves used for normal bowel movements.

Signs and Symptoms to Watch Out For

Everyone’s body, eating habits and metabolism are different, so there isn’t an ‘ideal’ when it comes to the frequency of bowl movements. Some people have bowel movements twice a day and for others, three times a week is normal. Chronic constipation is typically confirmed when you, or someone you are caring for, regularly experiences two or more of the following symptoms:

• Trouble having bowel movements (straining)
• Less than three stools per week
• Small, lumpy or hard stools
• A sense after bowel movements that further bowel movements still need to be passed
• Bloating, gas, cramps or abdominal pain

Someone with dementia or Alzheimer’s may not be able to realize or communicate these symptoms and may become irritable, agitated or even aggressive when they are constipated.

Untreated constipation can increase the risk of haemorrhoids, fecal and urinary incontinence and more serious conditions like fecal impaction where stool is stuck in the rectum which can result in hospitalization. Always make an appointment with your doctor if you have any unexplained and persistent changes to your bowel habits.

Red Flag Symptoms You Can’t Ignore  

If you or a loved one are experiencing any of the following symptoms with constipation, go to the doctor or emergency room right away:

• Significant abdominal pain
• Bloody stool or stool that is black, tarry or cranberry in colour
• A fever above 101 F
• Unexplained weight loss

Relieve and Prevent Constipation

For older adults without any red flags or other health concerns, constipation can often be improved and treated with lifestyle changes. Because constipation naturally increases with age, seniors need to be more diligent to prevent it. Here are some suggestions:

• Watch your Diet: Avoid food and drinks that are constipating like white rice and other refined grains, red meat, unripe bananas, cheese, caffeinated beverages and chocolate. Slowly incorporating more beans, whole grains, vegetables, fresh and dried fruit, nuts and other foods high in fibre will encourage more regular bowel movements. You may also want to consider a fibre supplement like Metamucil, but always check with your doctor first.
• Increase Fluids: Drinking enough water and other liquids will soften stool, making it easier to pass. Carry a water bottle with you, set alarms to remind you to regularly hydrate and don’t forget that food with higher water content—like cucumbers, apples, watermelon and peppers—also count towards your intake. Fruit-infused, plant-based or carbonated water, chilled herbal tea, smoothies, warm milk and low-sodium soup broth are other options if you don’t always find plain water appealing.
• Exercise Regularly: Regular physical activity is great for overall health and will also help regulate the digestive system. If you aren’t typically active, start with light exercise like walking, yoga and stretching. Slowly increase the amount and difficulty of activity, always in consultation with your doctor.
• Be Consistent. Try to respond immediately to the urge to pass stool, take your time and avoid straining. Aim to go the bathroom at around the same time every day, ideally first thing in the morning or after meals. In addition, get into a squatting position by elevating your feet on a stool and leaning forward and try gentle abdomen massage to encourage more comfortable bowel movements.

If these lifestyle changes aren’t resolving the issue, speak to a health professional to find the best next steps for you. Your doctor may suggest over-the-counter or prescription laxatives to help you establish and maintain regular bowel movements. Otherwise, remember to increase your fibre intake, drink lots of water and get active to help you enjoy more healthy and comfortable senior years.

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