Constipation in older adults: a problem worth discussing

A study led by Cedars-Sinai found that three out of five Americans with constipation had never mentioned it to a doctor. It's a problem that's extremely common and almost never said out loud. For older adults that silence has a cost, because constipation in older adults is more frequent, more often tied to medicines and other conditions, and more likely to turn into something worse if it's left alone.

Most of it is fixable, and most of the fixing happens at home. A family needs to know the usual causes, the plain steps that solve most cases, the few warning signs that need a doctor, and the way it can disguise itself in a frail parent.

Common, and rarely mentioned

A 2015 review in Canadian Family Physician found constipation in about 26% of women and 16% of men 65 and older living at home, rising to about 34% of women and 26% of men at 84 and older. In long-term care, where people move less and take more medicines, rates as high as 80% have been reported.

Left alone, constipation can lead to hemorrhoids, small tears and fecal impaction, a hard mass the body can't pass on its own. Caught early, it's solved with prunes and a walk. Left for months, it can end in the emergency room. That's the reason to ask the awkward question.

Why it gets more common with age

It's tempting to assume the bowel just slows with age. In healthy older adults that isn't the main story. What drives the higher rates is what builds up around the gut:

• Less fiber. Cooking for one gets harder, and softer, blander foods take over.
• Less fluid. Thirst fades with age, a pattern we cover in our guide to the signs of dehydration families miss.
• Less movement. Walking helps keep the bowel moving.
• More medicines and conditions. Diabetes, an underactive thyroid, Parkinson's disease and stroke can all slow things down.
• Ignoring the urge. Putting it off because the moment is inconvenient slowly throws off the body's rhythm.

The medicine cabinet does a lot of the damage

Medicines are the cause families overlook most and can do the most about. Common culprits:

• Opioid pain medicines, among the most reliable causes.
• Anticholinergic drugs, including the bladder medicine oxybutynin and sedating antihistamines such as diphenhydramine, found in many allergy and nighttime sleep aids.
• Some blood pressure medicines, especially the calcium channel blocker verapamil.
• Iron supplements.
• Antacids containing calcium or aluminum.
• Some antidepressants and several Parkinson's medicines.

The clue is timing. If constipation started within days or weeks of a new prescription or a higher dose, look at the bottle first. Don't stop a prescribed medicine on your own, since some are unsafe to stop suddenly. Gather every prescription, over-the-counter product and supplement and ask the doctor or pharmacist for a review. Our guide to medication management for seniors explains how.

What counts as normal

Healthy bowel habits range widely, from three times a day to three times a week, so frequency alone tells you little. What matters is a change from your parent's own normal, plus straining, hard or lumpy stools, or a feeling that the bowel never fully empties.

This is why constipation slips by in older adults who live alone. If no one asks, a parent may not mention it. A plain, matter-of-fact question now and then does more good than any chart.

Fixes that come before laxatives

The National Institute of Diabetes and Digestive and Kidney Diseases puts diet, fluids and activity first, and they work together:

• Add fiber slowly from fruit, vegetables, whole-grain bread and cereal, beans, and dried fruit. Prunes are the classic for good reason. Adding a lot at once causes gas and bloating.
• Drink with it. Fiber without enough fluid can make things worse.
• Move every day, even a short walk.
• Use the body's clock. The urge is strongest after meals, especially breakfast, so build in unhurried bathroom time then.
• Fix the posture. A small footstool that raises the knees above the hips straightens the angle of the lower bowel and makes passing stool easier.

Give these changes a few weeks, not a few days. Steady help makes them stick. Our caregivers keep fluids and fiber-rich meals on track and the daily walk on the calendar through companion care, and personal care handles toileting with privacy and dignity for those who need a hand.

Laxatives: useful, with some care

When those steps aren't enough, laxatives help, but they aren't all alike. Ask a pharmacist or doctor to match the type to your parent, especially with other medicines and conditions in the picture.

• Fiber supplements such as psyllium add bulk and need plenty of water.
• Osmotic laxatives such as polyethylene glycol draw water into the stool and are often a first choice for older adults. Magnesium-based laxatives and phosphate enemas can be risky with kidney or heart problems.
• Stool softeners ease straining, which helps after surgery or with hemorrhoids.
• Stimulant laxatives such as senna and bisacodyl work well for occasional use. Ask before using them every day.

Reaching for the same product every morning for months is itself a reason to check in with the doctor.

Warning signs that need a doctor

Call the doctor promptly for:

• Blood in the stool, or black, tarry stools.
• Unexplained weight loss.
• A new, lasting change in bowel habits.
• Severe belly pain, vomiting, or being unable to pass gas, which can mean a blockage.
• Tiredness and paleness that could mean anemia.

A family history of colon cancer or inflammatory bowel disease raises the stakes. Most constipation has an ordinary cause, but these signs justify a closer look, sometimes a colonoscopy.

When it shows up as confusion instead of discomfort

In a frail older adult, and especially in someone with dementia, constipation doesn't always look like constipation. It can show up as restlessness, new agitation, a lost appetite or a foggy drop in alertness, much like the pattern in our guide to UTIs and confusion in the elderly. The most misleading version is overflow: when stool is impacted, watery stool can leak around it and look exactly like diarrhea, sending families toward the wrong fix.

Because the person may never mention it, the safeguard is attention. A caregiver who keeps a quiet note of bowel movements often spots the gap before it becomes an impaction. That kind of everyday noticing is part of our in-home memory care.

Small habits that prevent most of it

A glass of water within reach. Fiber at breakfast and fruit later. A short walk. A footstool by the toilet. A medicine list a pharmacist has actually reviewed. And a willingness to ask the plain question. If your parent needs help keeping those habits going, call us or request care.

This article is general information, not medical advice. Any new, severe or lasting change in bowel habits in an older adult should be checked by a doctor.