I bet you've given all sorts of practical health advice to your family over the years, and doubtless received loads of health advice from professionals, relatives or friends. But when you have a problem yourself, I know that sometimes you just don’t want to make a fuss about it. I expect that’s why you are reading this, and looking for some information about how to relieve constipation and how to prevent it from happening again.
Constipation in the elderly, like in the young, can be caused by a diet lacking in fibre, or a low fluid intake, lack of exercise, and sometimes by emotional stress. Some medications such as antacids, tablets for high blood pressure, antidepressants and some pain killers can also upset the digestive system, so check the information leaflet that comes with all prescribed and over-the-counter medicines for any advice they might give.
When you are eating less food than you used to do, and maybe drinking less fluid than before, then your bowel movements will slow down. When stools remain in the large intestine for long periods, they can dry out and become hard. If you have less than three bowel movements a week, or have to strain when going, you probably have constipation.
A healthy bowel needs certain different kinds of food to remain efficient and trouble-free. These days you probably have simple foods at mealtimes that don’t require the time and effort you used to spend on preparation and cooking. But you can be missing out on some foods or ingredients that keep the bowel working well, particularly fibre.
Getting enough fibre or roughage is the most important thing you can do - whether elderly, middle-aged, or young and full of beans, so to speak. Fibre is absolutely essential for bowel regularity and prevention of constipation. You can get dietary fibre from wholemeal flour, vegetables, fruit and bran cereals. Non-fibre foods are digested quickly in the stomach and small intestine, but fibre gets to the large intestine where it stimulates the movement of stools, and also attracts water to keep stools soft and bulky. Try to follow the five portions of fruit and vegetables a day rule if possible. You can try the traditional remedies of eating foods known to have a laxative effect such as prunes or rhubarb, and herbs such as parsley and elder berry, but they don’t work for everybody.
But you can still have treats! I know how difficult it can be if you’re told to reduce cholesterol and should give up fatty fried foods or cheese, or you have to avoid sugar because you are diabetic. Buying foods that are fat reduced or sugar free always seem to be more expensive than the ordinary varieties. A tiny bit of cheese is fine now and again, and if you are diabetic you might still be able to have an occasional piece of cake, or a rare couple of squares of dark chocolate. I won’t tell if you don’t!
You also need to make sure you are drinking enough fluid, which helps to lubricate the passage of food and prevent it drying out along the way and causing constipation. The recommendation (unless you are fluid restricted) is to drink at least 1.5 litres (just over 2 pints) of water a day, and 2 litres (about 3½ pints) if you are eating a high-fibre diet, but make sure it’s little and often and not all in one go! Fruit juices are good because they can have a laxative effect, particularly prune, pear and apple juice. A glass of warm water in the morning can also help.
You are probably not getting as much exercise as you used to, maybe sitting for longer periods of time, and not getting out as much. Also, your muscle tone will not be as strong as it used to be, and bowel movements depend on good muscular contractions. Exercise really does benefit the digestive process, in the elderly and for everyone; because it stimulates the passage of food through the system (via peristalsis), thereby helping to prevent constipation. Even a short walk or movement around the house or garden every hour or two is good for digestion, as well as for your general health and wellbeing.
Any change to your normal environment or alterations to familiar routines can upset your digestion and cause a variety of health issues including constipation or diarrhoea. Even going on holiday can interrupt normal bowel habits, especially if different or exotic foods are eaten, and unfamiliar bacteria are experienced. This is a time to concentrate in particular on the advice about diet, fluids and exercise.
These days you might not go to the toilet when nature calls as quickly as you used to, because you might have difficulty getting out of your chair or bed, or you might use a wheelchair at other times. When you’re out you might prefer to avoid public toilets. Holding it in until later might not seem important, but it can cause constipation because waste matter is continually being collected ready for evacuation, becoming drier and harder the longer it’s kept waiting, and therefore more difficult to pass when you do go. Try to go to the toilet at the earliest possible convenience. Interestingly this piece of advice applies for both bowel movements and passing urine.
I expect the first thing you think about when constipated is taking a laxative, and there are many different types to choose from. Looking along the shelves at the chemist or pharmacy you will find stimulant laxatives which encourage intestinal muscle movement; bulk-forming laxatives that help to retain moisture in the bowel; stool softeners, and others which prevent stools from drying out and becoming hard. Ask the pharmacist for advice.
Like many medicines, laxatives can have some side effects such as wind and stomach cramps, and if you take more than is advised, you might then get diarrhoea. Some products warn you to check with your doctor if you have other medical conditions or are taking other medication. It’s not a good idea to use laxatives for more than a couple of weeks, because they can aggravate the large intestine over time.
You could try a more natural solution, using herbal remedies such as Barberry capsules, or ayuverdic remedies like Triphala. You may also have heard about probiotics. Probiotic supplements are a natural way to keep the bowels regular and the digestive process healthy by adding to the friendly bacteria in the gut. OptiBac Probiotics 'For maintaining regularity' is especially made to help maintain bowel regularity, and might well be worth trying as a natural supplement. It's also worth noting that there are various studies which show that this particular strain help with constipation in the elderly   without side effects.
If your constipation hasn’t improved after a couple of weeks, or you have any other symptoms such as nausea, painful abdomen, blood in your stools or you are losing weight, talk to your doctor.
References & Footnotes
Matsumoto M, Imai T, Hironaka T, Kume H, Watanabe M and Benno Y. Effect of Yoghurt with Bifidobacterium lactis LKM512 in Improving Fecal Microflora and Defecation of Healthy Volunteers. Intestine Microbiology Magazine 2001;14:97-102.
Murakami T, Miyahara H, Yukisato S, Nakamura R, Kanno H, Kotakemori M, Kamei T and Kobayashi O. Safety and effect of yoghurt containing Bifidobacterium lactis BB-12 on improvement of defecation and fecal microflora in healthy volunteers. Food, Health and Nutrition Research (Journal of Nutritional Food) 2006;9(1):1-12.
Uchida K, Akashi K, Kusunoki I, Ikeda T, Katano N, Motoshima H and Benno Y. Effect of fermented milk containing Bifidobacterium lactis BB-12 on stool frequency, defecation, fecal microbiota and safety of excessive ingestion in healthy female students -2nd report. Food Health and Nutrition Research (Journal of Nutritional Food) 2005;8(1):39-51.
Alm L, Ryd-Kjellen E, Setterberg G and Blomquist L. Effect of a new fermented milk product "CULTURA" on constipation in geriatric patients. 1st Lactic Acid Bacteria Computer Conference Proceedings. Horizon Scientific Press, Norfolk, England 1993.