Updated August 27, 2021

what questions should I and my family be asking?

• Am I having three bowel movements or less a week?

• Am I straining or having painful bowel movements?

• Am I taking any medications that can cause constipation?

• Am I drinking enough water and eating foods with high fiber?

• Does my belly bloat or is painful after I eat?

• Do I see blood in my stool after a bowel movement?

• Do I have any nausea or vomiting?

• Do I have a family history of colon cancer or bowel diseases?

• Do I have urinary symptoms such as burning when peeing or feeling my bladder is full despite peeing?

• Do I have an urgency to rush to the washroom to pee?

What actions can i take for this agenda?

• Drink lots of water (unless you have been told by your doctor not to because of another medical condition), and eat foods with high fiber

• Exercise and move often as this stimulates your gut to move too

• Consider using laxatives especially “Pegalyte” as it is better studied in older adults if lifestyle changes do not help. Talk to your doctor first

• Always talk to your doctor if you feel constipated so they can look for specific causes like thyroid problems, tumors, or bowel inflammation

• Review the medications you are taking with your doctor as some can cause constipation such as opioids and iron supplements

• Take advantage of the bowel’s natural time to have a movement especially after meals and in the morning

• Depending on your age and risk factors, you may need to be screened for colon cancer. Talk to your doctor about this

What does constipation mean?

• Constipation can have different meanings to different people. Even between patients and doctors

• Generally, constipation refers to the difficulty in having a bowel movement. Some see it as not going as frequently as one should. Others see it as straining or having pain when having a bowel movement

• If you have two or more of the following you are considered constipated:

• Having less than three movements per week

• Only having normal movements when using laxatives

• Straining and painful bowel movements 

• Lumpy hard stools

• A sensation of incomplete voiding of stool

• A sensation of bowel blockage

• Use your fingers to remove stool

How common is constipation?

• Some studies show that constipation is as common as 25% to 50% of older adults. Laxatives are used by over 20% of older adults

Constipation is common and can present as less than three movements a week or painful straining during a movement

WHAT INCREASES MY RISK OF GETTING CONSTIPATION?

• Female gender

• Low physical activity

• Depression

• Taking too many medications

• Medication side effects

• Eating and drinking less (especially water)

What are the alarming symptoms of constipation?

• Alarming symptoms are symptoms that are more serious when presenting with constipation

• Meaning it may not be from a simple cause such as not eating enough fiber or drinking enough water

• Alarming symptoms could mean you have a more serious diagnosis such as a long-term (chronic) illness

• Always talk to your doctor if you have constipation for a long time with the following alarming features:

• Blood that can be seen in the stool

• A medical history of anemia (low hemoglobin)

• Persistent constipation that doesn’t respond to treatment or laxatives

• Unintentional weight loss

• Family history of colon cancer or bowel diseases

• Sudden or severe start of constipation in older adults without a clear cause

Always talk to your doctor if you notice any “alarming” symptoms such as visible blood, weight loss, and a history of colon cancer

What is diarrhea?

• Diarrhea is considered to be the opposite of constipation

• Diarrhea can mean loose watery stools

• Diarrhea can also mean having many frequent bowel movements such as three times or more per day

• Having diarrhea can cause dehydration

• You lose important body salts (electrolytes) such as sodium, potassium, and magnesium

• There are many causes for diarrhea so talk to your doctor if you notice your stools are very frequent or loose and watery

Can constipation present with diarrhea?

• Yes. It may sound odd, but if one has a lot of stool blocking their bowels, it may look like diarrhea when it is constipation

• The watery parts can go around the hard stool and may cause what looks like diarrhea. This is called “overflow incontinence”

• It might be necessary to take laxatives to resolve it

• Always talk to your doctor to know if you are constipated or have a true diarrhea illness

diarrhea is the opposite of constipation. however, constipation can look like diarrhea if the hard stools let the watery parts pass

What are the main causes of constipation?

• There are many causes that can lead to constipation

• It is important to know the common causes. Some examples are:

• Hormone changes such as thyroid diseases

• Injury to the nervous system causing the nerves in your bowels not to work. Examples are diabetes, Parkinson’s disease, or spine injury

• Medication side effects such as from opioids like morphine

• Muscle blockage or injuries such as from a tumor or inflammatory disease in the bowels

• Low fiber diet and dehydration

What are bad outcomes that can happen from long-term or uncontrolled constipation?

• Increase the risk of hemorrhoids (abnormal large anal veins)

• Increases risk for bleeding from the rectum from cuts and tears

• Increases risk of urine retention and bladder infections (UTI)    

• Having long-term pain in your gut when you have a bowel movement

• Stool “impaction” meaning stools cause blockage of your bowels causing pain. If severe enough, a tear in the intestines can happen

there are many causes for constipation such as hormone changes, bowel diseases, cancer, and nerve injury

Constipation can cause hemorrhoids, blood in your stool, rectal cuts, and blocked bowels that can tear

Do I need any blood tests or imaging to diagnose constipation?

• Constipation is usually diagnosed without any tests. Sometimes your doctor may order some blood tests to make sure you don’t have a specific cause for constipation

• An x-ray of the gut can be done to see how constipated you are if you have gut pain and bloating

• The most important part of diagnosing constipation is to tell your doctor about your bowel movements

• They may also examine your belly and rectum

• Talk to your doctor to see if you need any tests or imaging done as you may not need any

Is there treatment for constipation?

• Your doctor must first make sure there is no specific cause to your constipation before starting treatment

• That’s because treating the underlying cause is very important

• After that, the first step in treatment is lifestyle and dietary changes

• Meaning, to eat more food with fiber and to exercise. You should also drink lots of water (so that your urine is a pale yellow color) unless you are told by your doctor not to because of another medical condition

• Having your bowel movements at the same time helps

• The best time to take advantage of having a bowel movement easily is after meals and in the morning time when you wake up

• After breakfast is usually an ideal time when your gut is more ready to have a bowel movement than other times

• If all of that does not work, then a trial of some laxatives can help with constipation. The best-studied laxatives in older adults are called “osmotic” laxatives

• The most commonly used type has many names but is called “Peglyte” or “Lax-a-day” or “Restoralax”

• Another common laxative that is studied is called “Lactulose”

• If those fail, other types of laxatives can be used. Talk to your doctor to learn more about them and what would be best for you

• Be careful to not cause diarrhea instead of constipation. If your stools become too watery and too frequent you may be taking too much

• Always talk to your doctor before starting laxatives to know which type and how frequently to use them

eating foods with high fiber and drinking a lot of water helps

the easiest time to have a bowel movement is in the morning after breakfast

“Peglyte” is the most studied laxative in older adults

Should I use enemas?

• Treating constipation usually doesn’t need the use of enemas or suppositories

• Only in severe cases that do not respond to treatment or in those that have a lot of stool in the rectum may benefit from these

• Even then, studies do not show much evidence for them. Always talk to your doctor before using them

• Some studies show using phosphate enemas can be harmful to older adults by losing important body salts (electrolytes)

What are examples of foods with high fiber?

• Fruits such as bananas, oranges, apples, mangoes, and strawberries

• Many vegetables and generally the darker the color the greater the fiber

• Beans such as those found in salads and soups

• Bread and grains such as wheat bread, granolas, and bran flakes

• Nuts such as almonds and walnuts

enemas are usually not needed. They are used for severe cases mainly

there are many foods with high fibers such as fruits, vegetables, bread, beans, and nuts

What resources can help with this agenda? 

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