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Managing the Symptoms of Constipation in the Elderly

HIGHLIGHTS:

  • Constipation refers to difficulties experienced during bowel movements. Persons affected must strain for long periods of time, and when they do manage to pass feces, they tend to be quite hard. Patients will still feel stomach pain when leaving the bathroom, as if they haven’t managed to pass the full amount of feces. Those suffering from constipation may experience less than three bowel movements per week.
  • Making behavioral adjustments can aid the bowel movement process. Such adjustments include being sure to drink 8-10 glasses of water per day, consuming a diet high in fiber, partaking in light exercise, practicing mental wellbeing and training oneself to go to the bathroom at the same times each day. Additionally, the elderly should not be given laxative medication for long periods of time, as they may come to rely on these drugs.
  • If a patient experiences constipation in conjunction with other health issues, such as a drop in body weight, passing blood, fecal abnormalities or a family history of colon cancer, that person should seek medical attention in order to diagnose the cause and receive appropriate treatment.

 

While constipation in the elderly can have a serious effect on their health and cause that person to lose their appetite, severe constipation can also lead to stress and depression. Such symptoms can affect the daily life of the sufferer during a time in their life when they should be free from any anxiety and feel able to enjoy every moment of their autumnal years with their families and loved ones.

When is it considered constipation?

A person is considered constipated when they experience difficulty during bowel movements that requires them to strain for long periods of time. Also, when they do manage to pass feces, they tend to be quite hard in texture. Another indicator is that the person will still have stomach pain when they leave the toilet, feeling as if they haven’t managed to pass the full amount of feces. In addition, they may experience less than three bowel movements per week. All of these symptoms are indicators of constipation.

The digestive process – from the time of consumption to the time of excretion – typically takes around 1-3 days to complete, depending on the person’s diet, the amount of water they consume, their exercise habits and their physical condition. For most people, the digestion process takes around one day. However, if the person does not excrete during this time, the feces may start to accumulate in the intestines. As this accumulation increases, it can cause the feces to harden, meaning that it becomes extremely difficult to pass.

What are the causes of constipation in the elderly?

Aside from the digestive system deteriorating with age, most elderly patients experience constipation due to a combination of the following factors:

  • Issues with the teeth and mouth: If these problems are not treated appropriately, they can lead to food not being chewed properly which, in turn, can cause indigestion after eating. Some patients may stop eating altogether in order to avoid such issues occurring.
  • Not drinking enough water: The elderly and incontinence go hand in hand. This means that many elderly people drink hardly any water, or even avoid drinking water altogether during the day which leads to constipation.
  • Lack of exercise: Movement can be difficult for the elderly as some are afraid of falling over, while others suffer from chronic illnesses or even fail to see the benefits of exercise.
  • Chronic illnesses: In addition to some forms of medication, some chronic conditions can lead to constipation.
  • Stress or bad habits regarding holding in bowel movements.
  • A diet with insufficient amounts of fiber: Fibrous foods are more difficult to chew, can be sticky and tough to break down. The elderly therefore tend to select foods which are soft and lacking in fiber.

Behavioral adjustments can ease the bowel movement process

  • If there are issues with the teeth and mouth, the elderly person should receive appropriate treatment to help them chew their food more easily, which will also help them to get more flavor out of their food.
  • Drink 8-10 glasses of water, spread out over the course of a day.
  • Consume a diet high in fiber to aid bowel movements.
  • Partake in light exercise as appropriate for their unique physical condition, such as taking a walk after eating or doing arm exercises in the morning, as these exercises will aid intestinal movements, thereby helping to ease bowel movements.
  • Practice mental wellbeing, undertake training to go to the bathroom at the same time each day and avoid taking laxative medication for prolonged periods, as this could lead to a reliance on said drugs and cause an inability to excrete without them.
  • Consult a doctor for advice on making adjustments to medication which may be causing the constipation.

Fiber: a digestive aid

The elderly generally require around 20-35 grams of fiber per day. However, in those suffering from constipation, the fiber intake should be increased to between 25-60 grams a day. A diet high in fiber will help add waste and weight to feces, while fiber also absorbs water which can make the fecal matter softer. This allows it to move through the digestive system more simply, making bowel movements easier.

The elderly often suffer from weak teeth, or a lack of teeth altogether. This can make chewing food quite difficult, thus causing indigestion. Moreover, fibrous foods usually come in the form of green vegetables and fruits which tend to be sticky and difficult to chew properly. Preparing food so it is softer and also easier to chew, digest and swallow, is therefore of huge importance to the elderly. This type of food preparation may take many forms, such as cutting, mincing or blending food, so that it is in small pieces before it is steamed, stewed or boiled to make it even softer.

Additionally, the following options are available to those wishing to increase their fiber intake:

  • Replace white rice with soft brown rice, oatmeal or whole wheat bread.
  • Increase the intake of grains and nuts, such as green beans and red beans, ensuring to boil them first so that they are soft enough for the elderly to eat.
  • Be sure to cut vegetables into small pieces, while also selecting soft vegetables. At least 100 grams of vegetables should be eaten with every meal.
  • Select fruits which are ripe rather than unripe, because this will make them easier to chew, digest and eventually pass through bowel movements.
  • Prepare foods so that they are appetizing by using ingredients which the elderly enjoy eating.
  • Drink plenty of water between meals and throughout the day.

Examples of foods that are high in fiber:

Name of food

Amount of fiber (in grams)

  1 cup of oatmeal (dry)

12.3

  8 pods of soft okra

4.2

  2 cups of boiled broccoli

3.3

  3/4 cups of boiled sweetcorn (seeds only)

2.4

  3/4 cups of boiled carrot

3

  1/2 a large avocado

6.7

  1 large banana

2.8

  1/2 a large Fuji apple (including skin)

2.1

Sample 1-day menu which contains at least 20 grams of fiber

Breakfast

  • Brown rice, prawn congee with tricolor vegetables (sweet corn, carrot and sugar snap peas), with a side dish of Wakame seaweed and a glass of soy milk containing basil seeds and Job’s tears.

Lunch

  • Soft-boiled brown rice
  • Deep fried prawns with tamarind sauce
  • Minced pork, spinach and shitake mushroom soupGreen beans in syrup (not too sweet)

Afternoon snack

  • Fruit shake (fiber included): 100 grams apple + 30 grams avocado + 2 tablespoons cooked oatmeal

Dinner

  • Soft-boiled brown rice
  • Steamed fish with ginger
  • Cabbage, minced pork and shitake mushroom soup
  • Cultivated bananas

Constipation is a common condition affecting the elderly, but one which can be managed through behavioral adjustments and adequate care provided by those close to them. However, if the elderly person experiences constipation alongside other health issues, such as a drop in weight, passing blood, fecal abnormalities or a family history of colon cancer, special care must be taken by those providing their care. If any of these problems persist, medical attention should be sought immediately.


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