It’s time to talk about constipation. Infrequent bowel movements or difficulty passing stools is extremely common, particularly for older adults. Chronic constipation affects up to 40 percent of adults over age 60 and, in a 2017 study published in the Journal of Clinical Nursing, older adults reported this ongoing condition negatively impacted their physical and mental health, as well as their social functioning. When untreated constipation progresses, complications can develop, including hemorrhoids, fecal impaction, colon perforation and bleeding, and bowel obstruction. Yet this uncomfortable and potentially serious condition is rarely discussed at doctor’s appointments. Fortunately, diet, physical activity, and open communication with one’s doctors can help relieve this unpleasant condition.
The Role of Diet: “The first strategy I recommend for dealing with constipation is to look at your overall diet and make sure it is high in fiber,” says Nicola McKeown, PhD, a scientist at Tufts’ Jean Mayer USDA Human Nutrition Research Center on Aging currently working to develop a publicly available dietary fiber database.
National nutrition guidelines recommend fiber intake of 25 grams per day for women and 38 grams per day for men aged 19 to 50 years, and 21 grams per day for women and 30 grams per day for men over 50. The best way to increase fiber intake is to consume plenty of high-fiber foods (such as beans, vegetables, fruits, and whole grains) and decrease intake of foods high in refined carbohydrates. “Consuming a variety of fiber-rich foods is good for constipation and for overall health,” says McKeown. “Fruits, vegetables, and wheat-bran-based breakfast cereals (if you eat cereal) are good choices.”
Fiber, the part of plants that cannot be broken down during digestion, adds bulk to the stool (which triggers the intestines to get moving) and holds water (softening the stool for easier passage). It also feeds gut microbes, which may contribute to gut health and regularity. (Fiber is also beneficial to overall health. See Tufts Health & Nutrition Letter, January 2019, for more information.) Additionally, be sure to drink plenty of fluids, as dehydration can contribute to constipation.
Other Causes: Getting little or no physical activity is a known constipation risk factor. Aerobic exercise (like walking, dancing, or swimming), stretching, and yoga may stimulate bowel function. A variety of medical conditions and medications also can contribute to constipation. Medical causes include gastrointestinal disorders like irritable bowel syndrome and diverticulosis; metabolic issues and endocrine disorders including diabetes and hypothyroidism; neurologic conditions such as Parkinson’s and multiple sclerosis; and problems with the muscles involved in elimination. Psychological issues such as depression and eating disorders are also risk factors for constipation, as are stroke and pregnancy. “Certain medications, including those for high blood pressure and depression, can cause constipation also,” says Harmony Allison, MD, a gastroenterologist at Tufts Medical Center.
When lifestyle and dietary modifications do not relieve constipation, bulk laxatives (also called fiber supplements) are often recommended. These include the extracted plant fibers psyllium and methylcellulose. “For my patients who want to try a fiber supplement, I recommend the kind you mix with water,” says Allison. “I don’t recommend fiber pills or fiber supplement bars. They can actually make constipation worse if you don’t drink enough water with them.”
Talk to a health professional before taking these or other laxatives (such as osmotics and stimulants), as they may interfere with certain medications or be contraindicated with certain medical conditions.
“Individuals with chronic constipation should talk to a doctor,” says McKeown. “A medical professional can rule out health problems and suggest treatments if diet and lifestyle changes aren’t enough.” Once potential medical causes are ruled out, cutting down on low-fiber processed foods, increasing intake of plant foods and fluids, and moving more can make a big difference to your intestinal health, and to your general health and well-being as well.