While most people turn to laxatives at the first sign of trouble, medical experts recommend you change your diet first.
If you’re like many older adults, your medicine cabinet is lined with various laxatives to ease constipation. Constipation is one of the most common gastrointestinal problems, affecting about 42 million people in the United States (National Institute of Diabetes and Digestive and Kidney Diseases). But doctors say laxatives should be a measure of last resort, not least because people can become overly dependent on them and they lose their effectiveness.
Constipation is a symptom, not a disease, and it differs for each person. There is no right number of daily or weekly bowel movements. For some, “being regular” can mean bowel movements twice a day. For others, having movements three times a week is normal. To determine if you suffer from constipation, ask yourself these questions (from the National Institute on Aging):
- Do you often have fewer than three bowel movements a week?
- Do you usually have a difficult time passing stools?
- Are stools often lumpy or hard?
- Do feel blocked or as if you haven’t fully emptied your bowels?
If you answered “yes” to one or more of these questions, you may have a constipation problem. Otherwise, you probably don’t.
The elderly are five times more likely than younger adults to develop problems related to constipation, according to the California State University-San Marcos Medical News. The reasons include:
Poor diet. Many older adults, especially those who are single, rely on convenience foods that tend to be low in fiber. Tooth loss may also make eating regular meals difficult. Many older adults thus choose soft, processed foods that lack roughage.
Inadequate fluids. Because many older adults suffer from urinary and stress incontinence, they often try to avoid urinating. Therefore, they may not drink enough liquid. In addition, if elderly people do not eat regular or balanced meals, they may not be getting enough fluids in their diet.
Lack of exercise. Inactivity or long periods in bed due to illness or following surgery may cause constipation.
Medications. Prescription drugs may lead to constipation. Common culprits include antidepressants, antacids containing aluminum or calcium, antihistamines, diuretics, painkillers and anti-Parkinson drugs.
How to Treat Constipation
While many people grab a laxative or suppository at the first sign of constipation, medical experts say that you should first change your diet and get more exercise.
The National Institute on Aging suggests that you:
- Add fiber to your diet by eating more fresh fruits and vegetables, either cooked or raw, and more whole-grain cereals and breads. Dried fruits, such as apricots, prunes and figs, are high in fiber. Avoid eating a lot of high-fat meats, dairy products and eggs, or rich desserts and sugary sweets, all of which may cause constipation.
- Add a small amount of bran to baked goods, cereal and fruit if your diet does not include natural fiber. This may cause some bloating and gas in the beginning. Make diet changes slowly to allow your system to adapt. Look for high-fiber products such as psyllium seed in the grocery store.
- Drink plenty of water and juice. The intestines absorb fluid, and people who don't drink adequate amounts of water may not pass enough water into the colon to keep their stools soft. Most experts recommend six to eight glasses of water daily. Minimize milk and milk products if these prove constipating.
- Avoid alcohol and caffeine. Beer, wine, liquor, coffee, tea and cola drinks increase urination, which leads to (relative) dehydration because of an increase in the intestine’s water absorption. This can lead to constipation when the stool does not retain enough fluid. In general, it is a good idea to have an extra glass of water for every cup of coffee, tea or alcoholic drink.
- Stay active. Even brisk walking may help stimulate bowel motility.
- Maintain regular bowel habits. Set aside time before or after breakfast to use the toilet. During the rest of the day, don’t ignore nature’s call, because that can lead to constipation.
Help from Medications
If drinking more liquids and eating more fiber doesn’t work, you may have to turn to supplements and medications to ease the situation.
If you can’t get enough fiber in your diet from foods, add a fiber supplement such as psyllium (Metamucil) and methylcellulose (Citrucel). In general, these fiber supplements are safe and effective if taken with sufficient water. They are not laxatives and must be taken regularly (whether you are constipated or not) in order for them to help you avoid future constipation. Start with one daily dosage, increase to twice daily after a week and then to three times daily after another week.
If this doesn’t work, doctors may suggest laxatives on a short-term basis. The Mayo Clinic lists the most common over-the-counter laxatives:
Drugs Target Constipation Caused by Painkillers
For adults who take painkillers such as morphine, codeine, oxycodone and methadone (brand names Kadian, Avinza, OxyContin, Percodan, Darvon, Demerol, Vicodin, Percocet and Lomotil), easing constipation can be difficult. Although patients taking opioids can experience a variety of gastrointestinal complaints, constipation is the most common, debilitating side effect of this drug therapy.
While doctors urge lifestyle changes, they might not be enough to combat what is referred to as opioid-induced constipation (OIC), which is unlikely to respond to increased dietary fiber, fluid intake or physical activity levels. To prevent OIC, doctors suggest scheduled laxative regimens. The most commonly used laxatives to treat OIC are stimulant laxatives (such as brands Ex-Lax Senokot and Dulcolax), which stimulate the lining of the intestine. Prescription medications specifically made to fight OIC include Amitiza, Relistor and Movantik. Your doctor can help find a regimen and drug that is best for you.
- Oral osmotic (brand names Milk of Magnesia and Miralax): They draw water into the colon from surrounding body tissues to allow easier stool passage. Side effects include bloating, cramping, diarrhea, nausea, gas and increased thirst.
- Oral bulk formers (Benefiber, Citrucel, FiberCon, Metamucil). These absorb water to form soft, bulky stool, prompting normal contraction of intestinal muscles. Side effects include bloating, gas, cramping or increased constipation if not taken with enough water.
- Oral stool softeners (Colace, Surfak): These add moisture to stool to allow strain-free bowel movements. Side effects include electrolyte imbalance with prolonged use.
- Oral stimulants (Dulcolax, Senokot): They trigger contractions of intestinal muscles to eliminate stool. Side effects include belching, cramping, diarrhea, nausea and urine discoloration.
- Rectal stimulants (Bisacodyl, Pedia-Lax, Dulcolax): These trigger rhythmic contractions of intestinal muscles to eliminate stool. Side effects include rectal irritation, stomach discomfort and cramping.
One problem with oral laxatives is that they can interfere with your body's absorption of some medications and nutrients. They can interact with blood thinners such as warfarin (Coumadin), some antibiotics and certain heart and bone medications.
In January 2014, the Food and Drug Administration issued a warning that exceeding one dosage of sodium phosphate (such as laxatives Phospho-Soda and Fleet enema) is potentially associated with serious side effects, such as dehydration and/or abnormal levels of electrolytes in the blood. These side effects can lead to serious complications, such as kidney damage and sometimes death. The agency recommends taking no more than a single dosage of the laxative once a day and to not use the product for more than three days. Patients older than 55 are at higher risk.
“Concerned About Constipation?” National Institute on Aging.
“Constipation in the Elderly,” California State University-San Marcos, Medical News.
“Safely Using Laxatives for Constipation,” WebMD.
“Constipation,” Mayo Clinic.
“Use Certain Laxatives with Caution,” Food and Drug Administration.
“Over-the-counter laxatives for constipation: Use with caution,” Mayo Clinic.
“Constipation in Adults,” emedicinehealth.
“Definition and Facts for Constipation,” National Institute of Diabetes & Digestive & Kidney Diseases.
Blog posting provided by Society of Certified Senior Advisors