How are your bowel movements? It’s not a question you often ask, even if you’re a caregiver. Yet, it’s an important question, especially for older adults, because it’s a marker of how effectively the digestive system is working. What’s more, both loose stools and – more commonly – constipation can affect quality of life.
Did you know?
The National Institutes of Health defines constipation as fewer than three bowel movements per week, with stools that are hard, dry or hard to pass. The Bristol stool chart, developed in 1997 by physicians Ken Heaton and Stephen Lewis at the Bristol Royal Infirmary in England, provides a reference for stool types: Types 3 and 4 on the chart are ideal, while types 1 and 2 indicate constipation, and types 5 through 7 lean toward diarrhea.
About 16% of U.S. adults experience constipation, but that number increases to around 33% in those 60 and older. Seniors are more likely to develop constipation for many reasons: They may be less mobile, they’re more likely to take medications or have chronic conditions that contribute to the condition, and they may not eat or drink enough. Structural changes like colon thickening, hemorrhoids and reduced abdominal strength may also contribute to the problem.
An older adult may not discuss constipation or digestion but instead may seem uncomfortable, decline to eat, or just become cranky or irritable. This is especially true for those living with Alzheimer’s disease and dementia, but it could be true for anyone, as we’re not in the habit of openly discussing what we do in the bathroom.
While constipation is uncomfortable, it can also be a health hazard. It can cause severe abdominal pain, hemorrhoids and even fecal impaction (a hard mass of stool stuck in the rectum), which usually requires suppositories or enemas and may require the help of trained clinicians.
Combatting constipation through diet
Over-the-counter laxatives may help with mild constipation or help temporarily, but the best ways to counteract constipation long-term are by adding fiber and drinking more fluids. Try to get 25 to 30 milligrams of fiber daily. For reference, a cup of cooked lentils contains 13.1 grams of fiber, a medium apple contains 4.4 grams, and a medium banana contains 3.1 grams.
Also, seek out foods with sorbitol, a sugar alcohol that’s a natural laxative, found naturally in most types of berries and other fruits like apples, cherries, avocados, peaches, etc. Another element that helps to keep bowel movements regular is pectin, a soluble fiber that absorbs water, which is found in carrots, oranges, apples, grapefruits and lemons.
A variety of foods have been known to help with constipation, so try incorporating these into your loved one’s diet:
- Whole wheat bread
- Whole grain pasta
- Prunes or prune juice (a good source of sorbitol)
- Ripe bananas
- Apples (with the skin on; a good source of pectin)
- Pears (with the skin on; a good source of sorbitol)
- Chia seeds or flaxseed (both of which can be ground and mixed into oatmeal, yogurt or pudding)
- Almonds, peanuts, pecans
- Coffee (which has caffeine that helps stimulate the gut)
- Ginger tea (a mild laxative)
- Water (which softens the stool and stimulates the bowels)
- Other liquids like juice and soup
- Soluble fiber supplements like Benefiber and Metamucil
- Probiotic supplements
Foods to avoid
Just as certain foods help with constipation, other foods should be avoided. To prevent constipation, stay away from these foods (or eat them only in moderation):
- Refined and processed grains like white rice and white bread
- Cheese and other dairy products
- High-sugar foods and other processed foods
- Fast food
- Fried food
- Red meat
- Alcohol (which can be dehydrating)
- Unripe bananas (which have high levels of resistant starch that can be hard to digest)
Other ways to stay regular
Physical activity is always a great way to get things moving through the system. If your loved one can walk or do more vigorous exercise, that activity should help with constipation. In fact, you may find that a senior who has had surgery and is bedridden for a while develops constipation issues that disappear once he or she is up and moving regularly.
It’s also a good idea to develop a routine around bathroom times. The body loves routine and adapts to it. Many people go first thing in the morning, but you may suggest your senior go after mealtimes. Whatever you do, make sure your senior never “holds” bowel movements.
Finally, and especially when physical activity is challenging, an abdominal massage can help. A massage therapist can help with this, but older adults can also try a self-massage. A caregiver can also take these same steps to massage an older adult.
When to see a doctor about constipation
It’s always a good idea to talk to a doctor about constipation or irregular bowel movements during visits. Be sure to speak to your doctor if you’ve tried over-the-counter remedies and dietary changes but are still not experiencing any relief. Also, contact a doctor immediately if there’s blood in the stool or if the constipation is combined with severe abdominal pain, nausea, vomiting or a fever.