Constipation in Elderly - Who Suffers

 

Older people are commonly treated for constipation. While experts believe constipation needn’t be a natural effect of ageing,
a general reduction in food and fluid intake, limited exercise and increased use of medications may be some of the reasons
why older people are commonly constipated.

For elderly people who have movement difficulties, trouble communicating, or who have moved into new surroundings (such as a nursing or care facility) there may be a tendency to deliberately “hold on” rather than respond to the natural urge to have a bowel movement. Over time, repeatedly ignoring the urge to go to the toilet can cause problems with constipation.

Exacerbating the problem can be the medications used to treat issues common in older age, some of which can have a constipation as a side effect. Older patients should let their doctor know if they begin to suffer constipation, as there may be alternative medications that won’t cause constipation.

A doctor should be consulted immediately if blood is found in a stool, or there is sudden unexplained weight loss or vomiting, as these could be signs of a more serious underlying condition.

Recognising Constipation
Causes and Symptoms
Chronic vs Occasional Constipation
Managing Constipation
Treatment options

RECOGNISING CONSTIPATION

Everyone's different, but a normal bowel habit is described as passing a stool that is soft and formed, with the a frequency of between three times per day and three times per week. Most people should be able to go without straining or delay, and have a sense of complete evacuation.

A normal bowel evacuation is usually passed within a minute of sitting down on the toilet, and there shouldn't be any discomfort.

The Bristol Stool Scale – a useful tool to help assess levels of constipation

If your poo most closely resembles Type 1 or 2 on the chart above, you are probably constipated, and should consider doing something about it. It's time to speak to a healthcare professional or try a treatment like MOVICOL® which is available over the counter from pharmacies.

CAUSES AND SYMPTOMS

What causes constipation?

For many people with constipation the cause isn’t easily identified, but there are some recognised risk factors, including:

• Lack of dietary fibre
• Inadequate fluid intake or dehydration
• Lack of mobility or not enough exercise
• Certain medications (consult the corresponding medication’s Patient Information Leaflet). It’s important to talk to your doctor if you think your medication is causing side effects.
• Certain medical conditions
• Deliberately withholding or ignoring the urge to go to the toilet
• Stress and changes to routine

Signs of constipation

Constipation can vary from occasional episodes – when symptoms can range from mild to troublesome – through to chronic (persistent) constipation. In any of these cases, there can be troublesome symptoms that impact quality of life.

Straining in at least one out of every four bowel movements as well as passing small dry stools less than three times per week can indicate constipation. Sufferers can also complain of bloating, pain, lethargy and generally feeling unwell.

Common constipation symptoms – checklist

• Feeling bloated or windy
• Fewer than three bowel movements a week
• A sense of an incomplete bowel movement
• Straining or suffering from pain when passing a stool
• Hard, dry stools
• Pain in abdomen
• Generally feeling unwell

If any of these symptoms continue more than two weeks, see a healthcare professional.

If you find blood in a stool, lose weight unexpectedly, or experience vomiting, go to see your doctor immediately, as these could be signs of a more serious underlying condition.

Download this stool diary to keep a record of your bowel movements to discuss with your doctor or pharmacist.

CHRONIC VS OCCASIONAL CONSTIPATION

For some people, constipation is an ongoing chronic condition that persists for months, years or throughout life. Symptoms may be troublesome, and impact on quality of life. Speak to your doctor about remedies and ways to manage the condition.

For others, constipation occurs only on occasions, and varies depending on its intensity.

MOVICOL® is a gentle and effective treatment for both chronic and occasional constipation. It has been available around the world for more than 20 years, and there are many clinical studies that prove its effectiveness and gentle mode of action. MOVICOL is available either by prescription from your doctor (PBS reimbursement is only available to eligible patients) or over the counter for chronic and occasional use. Different pack sizes and flavours are available.

For those who suffer chronic constipation, MOVICOL can be taken long term without loss of effect. Some studies actually show that doses of MOVICOL can be reduced over time. The long term use of laxatives should be under medical supervision

See here for causes and symptoms of constipation.

*Reference Gruss HJ and Teucher T, Treatment of chronic constipation - results of a multi-centre observation period on the use of
polyethylene glycol 3350 plus electrolytes, Kirchheim-Verlag Mainz 1999; 21(16): 1342-1350.

What is Faecal impaction

A doctor or nurse may use this term when there hasn’t been a proper bowel movement for several days – or even weeks. It means that poo has been building up in your intestines, becoming more and more difficult to get out.  Children with faecal impaction tend to have a dribbly bottom and often dirty their pants, which can be confused with diarrhoea and lead to the wrong treatment.

Faecal impaction needs to be confirmed by a doctor.

MANAGING CONSTIPATION

Healthy lifestyle measure are the best way to prevent constipation:

• Eat a balanced diet that includes plenty of fibre
• Drink plenty of fluids
• Exercise regularly, such as taking a brisk walk each day
• Try to avoid stressful situations

But sometimes this isn’t enough, and your body needs some help – whether it’s for a few days or longer. That’s where MOVICOL® comes in.

If constipation persists or becomes a concern, seek medical advice by visiting your doctor or pharmacist. Keeping a record of your bowel movements two weeks prior to your appointment can help your doctor in understanding and diagnosing your condition.

To assist with this, you may download or diary ready to fill in and take directly to you GP or pharmacist.

Keeping a diary

Keeping track of how often you pass stools and what they’re like can help with managing and preventing constipation in the future. This stool diary is an easy way to record useful information. Just print out and fill it in, then take it with you to your doctor on your next visit.

Click here to download the Stool Diary.

Toilet Tips

A normal bowel evacuation should take about a minute after sitting on the toilet, and there should be no discomfort or straining involved.

1. Never ignore the urge to go to the toilet
2. Don't rush going to the toilet
3. Try to establish a daily routine - sit on the toilet regularly, for example for 5 minutes after each meal or soon after waking up in the morning
4. Follow instructions below to position yourself correctly on the toilet

Do you have 'toilet phobia'?

For some people having a bowel movement can be quite daunting and can cause ‘safe toilet syndrome’ or ‘toilet phobia’. This condition can be caused by a variety of factors, including a bad experience or trauma. It may also be spurred on by fear of using public toilets, or unfamiliar surroundings. Some people have anxieties relating to a lack of privacy or a fear that the toilet is not clean.

It’s important that you don’t resist the urge to go to the toilet. There are ways to overcome your worries, such as counselling. You should speak to your doctor if anxieties are affecting your toilet habits.

If you have haemorrhoids

This can cause a fear of straining, but it is important that you do not hold on as it will worsen constipation. Using a laxative or stool softener may be recommended so that it doesn’t hurt as much as when passing the stool, and the haemorrhoid condition is not aggravated.

TREATMENT OPTIONS

Constipation in itself is not life-threatening, but there can be consequences if it is left untreated (including faecal impaction and haemorrhoids).

There are a range of constipation treatments available, that work in different ways. Your pharmacist or doctor can advise what’s best for you, depending on the severity and persistence of your constipation as well as factors like, age, lifestyle and other health concerns.

Some main treatment types are described below.

Bulk-forming laxatives

These work by increasing the amount of water in the stool, making it softer and easier to pass. Because bulk-forming laxatives work by absorbing water from your body, you need to stay well hydrated by drinking more than the usual (otherwise the constipation might actually get worse). For fit and healthy people with only mild constipation, bulk-forming laxatives may be an effective remedy, but they can take up to three days to work.

Faecal (stool) softeners

Faecal softeners also work in the intestine, enabling additional water and fat to be mixed into the stool, making it easier to pass. Their efficacy on their own is limited, so they are reserved for mild constipation.

Osmotic laxatives

They work by attracting water from the body into the gut so that more water is held there, softening the stool.

MOVICOL® is gentle and works in harmony with the body. The main active ingredient, macrogol 3350, goes straight to the bowel where, by retaining a set amount of water, it softens, expands and lubricates the stool to trigger peristalsis – in the same way as your normal bowel movement.

MOVICOL® does not ferment either, which means less likelihood of gas or bloating/wind.

Stimulant laxatives

Stimulant laxatives can be effective for the rapid relief of constipation. They cause bowel contraction through nerve stimulation. Tablets are usually taken at night and a bowel movement normally follows about 6-12 hours later.