Constipation in the Elderly (Infrequent Bowel Movements, Hard Stools) -
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Constipation in the Elderly (Infrequent Bowel Movements, Hard Stools)


Constipation in the ElderlyThere is no set definition for normal frequency of bowel movements but it is accepted that a person will pass stool anywhere between 3 times a day to 3 times a week. Defecation should not be difficult and the stool should be passed without strain or pain. Normal stool is firm yet soft, the shape being elongated and the color varying between tan and brown. Constipation is a condition associated with several types of abnormalities in defecation and with the shape and consistency of stool. Therefore constipation may be defined by one or more of the following criteria :

  • Fewer than 3 bowel movements in a week.
  • Difficulty and straining when passing stool.
  • Passing of hard, pellet-like stools.
  • Pain (abdominal and/or rectal) when passing stool.

 Causes of Constipation

Constipation is the one of the most common lower gastrointestinal tract disorders which may be acute (short-term) or chronic (long-term). Acute cases may be associated with a number of diseases or lifestyle factors that may not be directly related to the gastrointestinal tract. It is easily treated and may not recur again unless the contributing conditions arise again. Chronic causes may also be associated with these same factors but often there is no exact reason for long term constipation in which case it is termed functional. When this unexplained constipation arises on its own then it is known as functional constipation but if it is associated with other symptoms like abdominal pain and bloating then it is known as constipation-predominant irritable bowel syndrome (IBS), which is also a functional bowel disorder.

It is believed that functional constipation and constipation-predominent IBS may be due to slower than normal gastrointestinal motility which determines the speed at which food travels from the mouth to the anus (bowel transit time). This slow motility is not related to any disease but occurs for as yet unknown reasons. However, not every case of functional constipation can be explained by reduced motility and there could be other factors as problems with propulsive force in the rectum needed for defecation and disorders with the relaxation of the anal sphincters which allows for stool to exit the rectum and pass into the environment.

Despite the uncertainty about some of the causes of constipation, particularly chronic constipation, it appears to be associated with certain risk factors such as :

  • Low fiber intake
  • Low water intake
  • Reduced food intake
  • Sedentary lifestyle
  • Obesity
  • Certain medication
  • Excessive use of laxatives
  • After a severe illness
  • Hormonal changes (especially in women)
  • Restraining bowel movements on a regular basis despite the urge
  • Chronic disease like diabetes mellitus
  • Muscle and nerves diseases like Parkinson’s disease, stroke or spinal cord injury

Constipation in the Senior Years

With advancing age particularly in people 65 years and older, constipation becomes more likely for various reasons specific to this age group. Age-related changes in bowel activity tends to present as constipation even in the absence of any underlying disease. This is further exacerbated by poor nutrition like the tea and toast diet which is popular among the elderly, common electrolyte abnormalities such as low potassium levels, reduced physical activity particularly in a person who is immobilized with severe diseases or after falls with major injuries, and pelvic floor muscle dysfunction which is common in older age groups.

The likelihood of chronic diseases increases with advancing age and the elderly may suffer with several diseases concurrently. Diseases such as diabetes mellitus and Parkinson’s disease, which is more common in the elderly, is associated with constipation. In addition, spinal cord injuries which can occur after falls, particularly in the elderly who are more prone to falling and may sustain more severe injuries as a result of weaker bones, may also be responsible for constipation. The elderly are more likely to be using chronic medication, and several different types for co-existing chronic ailments, which may either cause constipation as a side effect or due to drug interactions amongst the various medications.

Constipation should be managed holistically with a focus on lifestyle management, dietary modification and the use of medication where necessary. Severe and prolonged constipation is more likely to lead to complications such as fecal impaction which may then require hospitalization or even surgical intervention. Therefore constipation, which is often seen as an acceptably common and mistaken as an innocuous bowel condition, can be serious if left untreated.

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