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Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
When meeting a patient for the first time, I make it a habit to ask about their bowel movements. While the odd person gets a bit squeamish at the somewhat graphic similes I use to get the best idea of their stool consistency (“humus or toothpaste?”), most welcome any advice I have to offer on this somewhat sensitive topic. When everything is running smoothly, we may not give much thought to our bowel health. But much like the flow of traffic, when things get sluggish, we take notice.
A common complaint in older adults
There are a few definitions floating around, but in general someone is suffering from constipation if they have fewer than three poops in a week, often accompanied by straining, hard stools or the sensation of not fully emptying the bowels.
Constipation can affect all ages, but it is more common in older adults, especially women. Researchers have found that 26 per cent of women and 16 per cent of men aged 65 and older reported being constipated.
While the natural effects of aging may lead to a slowing of the muscles of the large intestine, constipation in older adults is more often the result of other factors such as medications and supplements, reduced physical activity, diet, and chronic conditions such as diabetes or hypothyroidism.
If you are experiencing constipation, here are four strategies that can help.
1. Increase your intake of fibre and fluids
Many of my patients struggling with constipation worry that I’ll prescribe them yet another pill to help with their toileting troubles. But before I send them dashing off to the local drugstore in search of relief, I remind them to try a few simple dietary changes to promote regular bowel movements:
- Include plenty of high-fibre food choices in your diet, including fruits, cooked vegetables, beans and whole-wheat bread.
- Ensure you’re taking in about 1.5 litres of fluids every day. Dehydration exacerbates constipation and is often seen in older adults owing to decreased thirst drive as we age, so it’s important to drink plenty of water and other fluids.
- Reduce your intake of refined cereals and dairy while suffering from constipation, as these foods can bind and harden stool.
2. Adjust your toileting routine
Some people may find it beneficial to attempt toileting shortly after eating a meal to take advantage of the gastrocolonic reflex, wherein the arrival of food in the stomach triggers a massive smooth muscle movement in the large intestine.
Using a footstool while toileting may also be helpful; previous studies have shown squatting allows for better engagement of the abdominal muscles and improved relaxation of the muscles of the pelvic floor, facilitating defecation.
Finally, don’t ignore the urge to go, as delaying bowel movements not only allows stool to become drier and harder, but it can impair the signals from the rectum that it’s time to empty.
3. Check your medicine cabinet
Some types of medication may cause constipation by slowing the muscle action of the large intestine. Common culprits include opioids and narcotics used to treat both acute and chronic pain, older classes of antidepressants sometimes prescribed for nerve pain, and medications used to treat overactive bladder, a condition affecting about one in five older adults.
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Over-the-counter medications – including anti-inflammatories such as ibuprofen or naproxen – and supplements such as iron and calcium can also cause problems.
Check with your primary care provider to see if your medications or supplements might be making your bowel movements literally harder, and whether any adjustments are needed.
4. Consider over-the-counter remedies
If things are still moving too slow for comfort, it’s reasonable to try a short course of over-the-counter remedies.
Fibre supplements (such as Metamucil), which can be purchased in the form of a dissolvable powder or an oral capsule, help make stool softer and larger, thereby stimulating greater muscle movement through the large intestine.
The over-the-counter laxative PEG (Polyethylene glycol) 3350 (sold as Restoralax or Lax-A-Day) is tasteless and well-tolerated, and works by drawing water into the large intestine.
Sennoside tablets (sold as Senokot) act by irritating the muscles of the large intestine, promoting contraction and movement of feces.
Suppositories and enemas are also available over the counter; however, I don’t recommend these as a first-line remedy for my patients given that they can be tricky to self-administer.
While these types of over-the-counter products are generally safe for short-term use, please check in with your primary care provider if you’re contemplating using them for more than a few days.
Check with your doctor if constipation continues
If the strategies above don’t help, it’s important to make sure nothing serious is affecting your bowel health, particularly if you have a family history of colon cancer. Constipation occurring alongside other symptoms such as bloody stools or unintentional weight loss, or a sudden change in your defecation pattern, needs to be investigated further. As a first step, expect your family physician to ask about how often you have a bowel movement and the consistency of your stool.
It’s common for adults to be less forthcoming about their defecation difficulties unless asked. But don’t be shy – we’re happy to get things moving in the right direction.
Dr. Carolyn Wong is a family physician in Calgary with a focused practice in caring for older adults. She works in clinical settings, long-term care, and on home visits in the community. Dr. Wong is also heavily involved in medical education at the Cumming School of Medicine and Department of Family Medicine at the University of Calgary.
