What causes severe constipation in the elderly?

According to the National Institute on Aging, constipation is a common complaint among older adults, often becoming more severe with age. This happens for many reasons, from lifestyle factors to underlying health conditions. Understanding what causes severe constipation in the elderly is the first step toward effective management and relief.

Quick Summary

Several factors contribute to severe constipation in seniors, including slower digestion, dehydration, lack of fiber and exercise, certain medications, and underlying medical conditions. Age-related changes, along with poor diet and sedentary habits, can significantly impact bowel function, making a holistic approach to care essential for improving digestive health.

Key Points

• Age-Related Changes: Natural slowing of the gastrointestinal tract and weakening of pelvic floor muscles are significant contributors to constipation in seniors.

• Lifestyle Habits: Insufficient water intake, a diet low in fiber, and a sedentary lifestyle can all worsen or cause severe constipation.

• Medication Side Effects: Many common drugs taken by the elderly, such as painkillers, antidepressants, and blood pressure medications, are known to cause constipation.

• Underlying Health Issues: Chronic conditions like diabetes, hypothyroidism, and certain neurological or gastrointestinal diseases can be the root cause.

• Laxative Dependency: Overuse of stimulant laxatives can lead to the bowels becoming reliant on them, causing the issue to persist or worsen.

• When to See a Doctor: Persistent or severe constipation, especially when accompanied by other symptoms like weight loss or bleeding, requires prompt medical evaluation.

The physiology of aging and its impact on digestion

As the body ages, several physiological changes occur that can affect the digestive system, making severe constipation more likely. The entire gastrointestinal (GI) tract can slow down, leading to a condition known as reduced intestinal motility. This means that waste moves more sluggishly through the intestines, giving the body more time to absorb water and resulting in harder, drier stools that are difficult to pass.

Weakening abdominal and pelvic muscles

Over time, the muscles in the abdomen and pelvic floor, which are crucial for the process of defecation, can lose strength and coordination. In some cases, this leads to a specific type of constipation called pelvic floor dysfunction or outlet constipation. When these muscles don’t work together effectively, it can create a feeling of incomplete evacuation, even when a bowel movement occurs.

Lifestyle factors contributing to severe constipation

Beyond the natural aging process, several lifestyle habits common among the elderly can exacerbate or directly cause severe constipation.

Inadequate fluid intake

Many older adults may drink less water to avoid frequent urination, a common side effect of conditions like urinary incontinence. However, adequate hydration is essential for maintaining soft, easy-to-pass stools. When the body is dehydrated, it draws moisture from the colon, resulting in hard, lumpy stools that are difficult to move.

Low-fiber diets

Dietary fiber adds bulk to stool, helping it to move smoothly through the digestive system. Unfortunately, older adults might shift to diets with softer, processed foods that are lower in fiber, especially if they have dental problems or difficulty chewing. This lack of dietary fiber is a primary cause of constipation.

Lack of physical activity

An active lifestyle promotes healthy bowel function. For seniors who are sedentary or have mobility issues, the lack of movement can cause the intestines to become sluggish. Prolonged bed rest, often following an illness or accident, is a significant contributor to severe constipation in older adults.

Overreliance on laxatives

Misuse or overuse of stimulant laxatives can train the bowels to become dependent on them to function. Over time, the natural bowel rhythm weakens, making the issue of constipation worse when laxatives are not used.

Medications as a major culprit

Many medications prescribed to older adults have constipation as a common side effect. It is a critical factor to consider when investigating the cause of severe constipation.

Medications that can cause constipation:

• Opiate Painkillers: Morphine and codeine are notorious for causing significant constipation.
• Antidepressants: Specifically, tricyclic antidepressants can slow down the digestive system.
• Antihistamines: Used for allergies, these can have a drying effect on the body, including the intestines.
• Diuretics: These medications increase urination, potentially leading to dehydration and harder stools.
• Calcium Channel Blockers: Used for high blood pressure, these can relax the smooth muscles of the digestive tract.
• Iron and Calcium Supplements: Both can contribute to constipation.
• Antacids: Some antacids containing aluminum or calcium can cause or worsen constipation.

Underlying medical conditions

Severe constipation can also be a symptom of a more serious, underlying medical condition. It is vital to consult a healthcare provider to rule these out, especially if the constipation is new or worsening.

Conditions linked to constipation:

• Endocrine Disorders: Conditions like diabetes and hypothyroidism (underactive thyroid) can affect digestion.
• Neurological Conditions: Diseases such as Parkinson's disease, multiple sclerosis, and spinal cord injuries can impact nerve function related to bowel movements.
• Gastrointestinal Diseases: Conditions like Irritable Bowel Syndrome (IBS), diverticular disease, or even colon cancer can manifest with severe constipation.

A comparison of constipation risk factors in the elderly

Factor	Impact on Constipation	Why It Affects Seniors
Slower Digestion	Reduces intestinal motility, leading to drier, harder stools.	Natural weakening of the GI tract muscles with age.
Dehydration	Decreases water content in stool, making it difficult to pass.	Seniors may intentionally limit fluids due to urinary issues or forgetfulness.
Low Fiber Diet	Results in smaller, less bulky stool that is harder to move.	Dietary changes due to dental problems, appetite changes, or reliance on processed foods.
Inactivity	Slows intestinal muscle contractions, leading to sluggish bowels.	Limited mobility from injury, illness, or general weakness.
Medications	Many common drugs have side effects that slow GI movement.	Polypharmacy (taking multiple medications) is common in the elderly.
Pelvic Floor Dysfunction	Impairs muscle coordination needed for effective bowel evacuation.	Age-related weakening of the pelvic floor muscles.

Diagnosis and when to seek medical help

For persistent or severe constipation, a doctor will conduct a thorough examination, including a review of medications, diet, and lifestyle. They may also order tests to check for underlying conditions, especially if there are other symptoms like unexplained weight loss, fever, or blood in the stool. Early diagnosis and treatment are crucial to prevent complications and improve quality of life. Seeking advice from a doctor is always the best course of action. For more information on general digestive health, you can visit the National Institute of Diabetes and Digestive and Kidney Diseases.

Frequently Asked Questions

Why does constipation get worse with age?

Constipation often worsens with age due to several physiological changes. The intestinal muscles that move waste through the body can weaken and slow down, a process known as decreased motility. Additionally, many older adults are less active, may not drink enough fluids, or might be taking medications that cause constipation as a side effect.

What is the best way to treat severe constipation in the elderly?

Treatment for severe constipation in the elderly should be managed with guidance from a healthcare provider. Non-medicated approaches include increasing fiber intake from whole foods, ensuring adequate hydration, and incorporating gentle, regular physical activity. A doctor can also review current medications and recommend appropriate, short-term use of laxatives if necessary.

What medications are most likely to cause constipation in seniors?

A wide range of medications can cause constipation, but some of the most common offenders for seniors include opiate painkillers, antidepressants (especially tricyclics), antihistamines, diuretics, and certain blood pressure medications like calcium channel blockers. Always discuss your medications with a doctor if you suspect they are causing bowel issues.

Can dehydration cause severe constipation in the elderly?

Yes, dehydration is a major cause of severe constipation. When an older adult does not consume enough fluids, the body draws water from the colon, resulting in hard, dry stools that are difficult and painful to pass. This can be exacerbated if the person is also on diuretics.

Is lack of exercise a cause of severe constipation in the elderly?

Yes, a sedentary lifestyle or lack of physical activity is a significant factor. Exercise helps to stimulate the muscles of the intestines, promoting healthy and regular bowel movements. For seniors with limited mobility, even gentle movement or walking can be beneficial.

What dietary changes can help severe constipation in the elderly?

To help with severe constipation, seniors should focus on increasing dietary fiber by eating more fruits, vegetables, and whole grains. Prunes, bran, and other high-fiber foods can be particularly effective. It's important to introduce fiber gradually and increase fluid intake simultaneously to prevent gas and bloating.

When should I take an elderly person to see a doctor for constipation?

You should seek medical advice for an elderly person if their constipation is new or suddenly worsening. It is especially important if they also experience severe abdominal pain, unexplained weight loss, blood in their stool, fever, nausea, or vomiting. These symptoms could indicate a more serious underlying condition.