Constipation is an uncomfortable situation no matter your age. But for older adults, it’s a more common condition that can come with serious complications.
In this article, you’ll learn what causes constipation in older adults, who’s most at risk, and how older adults can prevent and treat it.
Constipation is a term used to describe when you have three or fewer bowel movements in a week. It can also be used to describe a situation where you’re unable to completely empty your bowels. Many people even consider themselves to be constipated when they need to strain to have a bowel movement.
Constipation happens to everyone from time to time, but when it becomes regular, it can be a problem.
When stool accumulates in the large intestine or colon for too long, it can become hard and dry, and more difficult to pass. About 16 percent of adults experience chronic constipation. This percentage increases to about a third of adults over age 60 and about half of all adults living in nursing homes.
The two main types of constipation in people of all ages are primary and secondary constipation.
Primary constipation, also known as functional constipation, happens when your problem is related to your bowel function and is not caused by another medical condition or medication. Functional constipation is divided into three subgroups:
- normal transit constipation
- slow transit constipation
- disorders of defecation
It’s possible to have more than one of these subtypes of functional constipation at once. Normal transit constipation is the most common and occurs when your stool moves at a regular frequency but is hard and difficult to expel.
In slow transit constipation, the bowel itself moves stool slowly for one reason or another, with delays in emptying. This often happens in people with metabolic disorders like diabetes and hypothyroidism.
With disorders of defecation, problems in the musculature of the rectum dampen the urge to defecate, causing stool to build in the colon without release.
Secondary constipation is when your bowel problems develop as a result of some other medical, physical, or structural problem. It can also be caused by a medication or treatment you’re taking. Examples include:
- taking more than five different regular medications
- having a chronic disease
- having mental health concerns
Lots of things in our bodies change as we age. Systems slow down and lose efficiency. Diets change, and living situations shift.
Constipation increases in frequency throughout adulthood, with the biggest jump after age 60. This is especially true for people who live in assisted care facilities, such as nursing homes.
There are many causes of constipation among older adults, including:
- reduced mobility
- multiple chronic illnesses
- not eating and drinking enough
It’s also important to understand that the risk of various medical conditions and structural changes goes up as we age. This can include things like:
- colon thickening
- stenosis of the anus
- rectocele, which is when the rectum bulges into the vagina
- loss of abdominal strength
- motility disorders
- bowel obstructions and perforations
If you have several medical conditions or take a high number of medications, you may think that constipation is inevitable. But there are steps older adults can take to make sure things keep running smoothly, including:
- drink plenty of water
- stay active
- get regular exercise
- aim for 25 to 30 grams (g) of fiber in your daily diet
- time your toileting efforts regularly after meals
What are the best foods for older adults with constipation?
- whole wheat bread
- whole grain pastas
- black beans
- apples with the skin on
Fast foods, fried foods, and processed foods should be avoided, as these contain little or no fiber. High sugar foods and dairy can also increase your risk of becoming constipated.
Ideally, you’ll be able to resolve your constipation without the use of medications.
The first goal in treating constipation is to reduce symptoms like abdominal pain and bloating. The second goal is to have regular, soft bowel movements that don’t require you to strain at least three times each week.
Exercise, hydration, and diet changes — especially increased fiber intake — are usually the first suggestions your doctor will make to reach these goals.
If nonmedicinal methods don’t work, your doctor may examine you for fecal impaction. This is a condition that develops when hard, dry stool becomes packed into the colon, making it difficult for stool to pass. In some cases, liquid stool may be leaking around the impaction, concealing the impaction. This is called overflow diarrhea.
If you have impacted stool, resolving this issue must be the first step. This condition is treated either with an enema or manual disimpaction. Manual disimpaction carries risk, so be sure to let your healthcare professional perform this task, or instruct you carefully on how to do it.
For constipation without impaction, there are several other behavioral and medication options you can try to help move your bowels.
Behavioral options may include things like:
- scheduling toileting efforts after mealtime
- planning regular times to attempt a bowel movement
- using a stool under your feet during a bowel movement
- providing adequate time and privacy
- avoiding bedpans
Medication options are divided into categories based on how they work. It may help to understand what type of constipation you have, and what’s causing it when choosing the right medication.
Most of these are available as over-the-counter (OTC) products, but your doctor can advise you on which to take or provide you with other prescription options if these don’t produce results.
- methylcellulose powder (fiber supplements), 19 g a day
- polycarbophil (FiberCon) tablets, 1,250 milligrams (mg) one to four times a day
- psyllium fiber (Metamucil), 1 teaspoon or 1 packet one to three times a day
Osmotic laxatives work by attracting water to your colon. This helps keep your stool soft and hydrated to make a bowel movement easier. Examples of these, and their recommended dosage, include:
- lactulose solution, 15 to 30 milliliters (mL) per day
- magnesium citrate solution, 150 to 300 mL as a single dose or for short-term daily use
- magnesium hydroxide suspension, 30 to 60 mL per day
- polyethylene glycol powder (Miralax), 17 g per day
- sorbitol solution, 2 to 3 tablespoons as a single dose or for short-term daily use
Stool softeners do just what they say — they make stools easier to pass. The main type of stool softener is docusate sodium capsules or Colace.
- bisocodyl (Dulcolax) tablets, 5 to 15 mg a day
- senna tablets, 15 mg a day
Reaching the age of 60 is a risk factor for constipation all on its own, but there are others, too.
Women have constipation
- eat a low fiber diet
- are sedentary or immobile
- are dehydrated
- don’t consume enough food and water
- take multiple medications
- lack the ability to have time and privacy for bowel movements
Most people will experience constipation at some point in their lives, but chronic constipation is much more common in older adults and those living in nursing homes.
Maintaining a healthy high fiber diet and getting regular exercise can help. But injuries, medications, and general aging issues can make avoiding constipation difficult.
There are many treatments available for constipation. If you’ve tried OTC methods without relief, talk with your doctor about additional treatment. This can help you avoid complications like bowel obstructions, perforations, and gastrointestinal bleeding.
Can milk or dairy cause constipation in older adults?
Milk or dairy can contribute to constipation, but not always. For some people who are sensitive to the proteins in cow’s milk, dairy can also cause diarrhea. It may help to keep a food diary of what you eat before becoming constipated. Also, try limiting the foods that appear to be linked to your constipation.
Can constipation cause confusion in older adults?
Constipation can lead to confusion or agitation in several ways. Discomfort from pain and bloating, or frustration of limited time and privacy for bowel movements can all lead to confusion — especially in older adults with conditions like dementia. Behavioral training or additional antipsychotic medications may be required in severe cases in which continued constipation could lead to impaction.
Is constipation different in older men and older women?
Both older men and women have an
Constipation is something everybody faces at some point in their lives, but it’s a more common — and often more serious risk — for older adults.
A healthy high fiber diet, plenty of water intake, and exercise can help reduce the risk of becoming constipated. But if you do have constipation, there are numerous medications and treatments that can help.
If you become constipated and OTC medications and lifestyle changes aren’t working, talk with your doctor about other options to avoid more serious complications.