Nurse’s Guide to Constipation Treatments For the Elderly

• Understand the importance of constipation, especially for elderly patients who may have worsened consequences due to the consequences of aging.
• Learn the two types of constipation, primary and secondary, as well as how it may change the type of constipation treatments you offer to your patient. 
• Review constipation treatments such as pharmaceutical interventions such as MiraLAX, or nutritional changes to increase fluid and fiber consumption. 

Constipation is not a fun subject for anyone to discuss, but in the elderly population, untreated constipation can have profound effects. Constipation can severely impact the quality of life and dignity of the elderly patient. Struggling with this issue can often be embarrassing for elderly patients, and fortunately, it is usually possible to effectively manage and prevent constipation.  

Constipation is often overlooked and not considered as a serious concern; however, chronic untreated constipation can lead to a more serious medical issue such as bowel obstruction, rectal prolapse, and anal fissure. Due to the complexity of constipation and the many possible causes, it is important for the long-term care nurse to have bowel maintenance plans for their patients, especially those who are at increased risk of constipation.  

Bowel maintenance plans are a tool that will help the nurse document how often the elderly patient is able to pass stool and catch constipation symptoms early, preventing serious illness. 

Definition of Constipation 

Constipation is identified as stool that accumulates in the large intestine or colon and becomes complex, dry, and more challenging to pass.  

Types of Constipation  

Primary constipation 

Also known as functional constipation, primary constipation is caused by an issue related to bowel function and is not caused by another medical condition. Primary constipation can be divided into three groups: 

• Normal transit constipation is the most common type of constipation and happens when the stool moves regularly but is challenging and complex to pass. 
• Slow transit constipation: this is when the bowel moves too slowly and is noted most commonly in those with diabetes or hypothyroidism.  
• Disorders of defecation: this is when there are problems with the rectum that damage the urge to pass stool, causing build-up.  

It is important to note it is possible to experience more than one of these at a time.  

Secondary constipation 

This type of constipation develops due to physical illness, medical issues, or medication side effects. Some examples of secondary constipation include: 

• Taking more than five medications a day 
• Chronic disease 
• Mental health concerns 

Symptoms of Constipation 

There is no correct number of daily or weekly bowel movements. Being regular can be different for each person. However, if the elderly adult often has infrequent bowel movements, they may be constipated. Symptoms of constipation include: 

• Fewer than three bowel movements a week 
• Difficulty passing stools 
• Lumpy or hard stools 
• A feeling of being blocked or not having fully emptied the bowels 

Physical examination to assess for pain and detect abnormal bowel sounds is essential when evaluating for constipation. It is vital to palpate the lower left abdominal quadrant to determine if the bowel is impacted with fecal matter.  

Vulnerable Population for Developing Constipation 

Physical changes due to aging make constipation more likely in the older population. These changes may be colon thickening, narrowing of the anal canal, rectocele development (in a female, where the rectum bulges into the vagina), motility disorders, and loss of abdominal strength.  

Other Causes of Constipation 

Many medical conditions that are common in older adults, as well as medications, can cause constipation.  

Medical conditions may be: 

• Disorders that affect the muscles or nerves used for normal bowel movements. For example, stroke, Parkinson’s disease, or a spinal cord injury can all cause constipation. 
• Conditions that affect hormones or metabolism, such as diabetes and hypothyroidism, can also lead to constipation. 
• Other medical conditions that can lead to constipation include tumors or other blockages and pelvic floor disorders such as pelvic floor dysfunction. Hemorrhoids and gastrointestinal disorders such as irritable bowel syndrome are also known to cause constipation.  
• In addition to these, those struggling with Alzheimer’s, or another form of dementia may struggle with constipation.  

Medications that Cause Constipation 

Drugs used to treat depression, antacids containing aluminum or calcium, allergy medicines, painkillers, muscle relaxants, overactive bladder medications, high blood pressure medications, iron supplements, and diuretics can all contribute to constipation. Anesthesia can also lead to constipation. 

Nutrition and Activity that Affects the Digestive System 

• Lack of fiber: Constipation is likely if there is not enough fiber in the diet.  
• Not enough fluids: Water and other fluids help fiber work better. Lack of hydration makes it harder to pass stools.  
• Lack of physical activity: Not getting enough movement in the day slows the digestive system, causing difficulty passing stool.  

Best Foods for Older Adults Struggling with Constipation

Oatmeal, whole wheat bread, whole grain pasta, lentils, black beans, soybeans, chickpeas, berries, prunes, oranges, pears, apples with the peel on, carrots, broccoli, peas, almonds, peanuts, and pecans are all great food choices packed with fiber to aid the digestive system in passing stool regularly.  

Constipation Treatments

When treating bowel problems, it is important to focus on prevention as well as finding the best solutions for the problems that have evolved. The type of treatment will depend on the cause of the constipation.  

Natural treatments: lifestyle changes mentioned above, such as eating more fiber, increasing physical activity, and having a toileting routine.  

Medication treatments: osmotic laxatives such as MiraLAX, fiber supplements such as Metamucil, or stimulant laxatives such as Senna.  

If natural or medication treatments do not work in treating constipation, it is important to follow up with the patient’s primary care physician to rule out other causes. In some cases, certain medications may need to be discontinued or changed to resolve constipation.  

The Bottom Line

In conclusion, constipation is an issue nearly everyone struggles with at some point in their lives, but it is more common and often a more serious risk for older adults.  

Initiating bowel maintenance plans, ensuring elderly patients receive adequate fiber in their diet, drinking enough water, and getting enough movement and exercise can drastically reduce the risk of constipation and improve overall physical and mental health in the elderly patient.  

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