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Constipation in Older Adults

Have you noticed that bowel movements are becoming less frequent, or that emptying the bowels has become difficult and painful?
 In this article, you will learn what constipation is, what its symptoms and causes are in older adults, as well as natural ways to ease the problem.

What is constipation?

Constipation refers to infrequent or difficult bowel movements. In older adults, the large intestine moves stool more slowly, which leads to increased absorption of fluid and the formation of hard, dry stool.

In practice, constipation is defined as having fewer than three bowel movements per week. It is often accompanied by straining during defecation and a feeling of incomplete emptying.

Normally, the large intestine absorbs water from food and forms stool, which then moves toward the rectum through rhythmic contractions of the intestines (peristalsis). In constipation, the transit of stool through the colon slows down, which makes evacuation even more difficult.

In older adults, reduced physical activity, changes in gut microbiota, and decreased tone of the smooth muscles of the intestines make them particularly prone to constipation.

Causes of Constipation in Older Adults

Constipation in older adults usually develops as a result of a combination of physiological changes and lifestyle factors.
 Here are the main factors that make bowel movements more difficult:

Slower peristalsis and reduced nerve stimulation in the elderly


 As the digestive system ages, the rhythmic contractions of the intestines (peristalsis) slow down, which prolongs the transit of intestinal contents through the colon. The longer stool remains in the intestines, the more fluid is absorbed, making it dry, hard, and difficult to pass.

In people over the age of 65, the number of enteric nerve cells decreases, which reduces the nerve stimulation needed to keep the intestines moving. At the same time, the tone of the smooth muscles in the intestinal wall (atonia intestinalis) declines, while the anal sphincter and pelvic floor muscles weaken, making normal defecation more difficult. In women, these changes are especially pronounced after menopause or as a result of difficult childbirth.

Reduced physical activity


 Prolonged sitting or reduced mobility due to general weakness, arthritis, or recovery from injuries such as hip fractures in older adults slows down metabolism and intestinal peristalsis. This factor further complicates bowel emptying and contributes to the development of constipation.

Inadequate fluid intake


 With age, the sensation of thirst decreases, and some older adults deliberately limit their water intake because of frequent urination or urinary incontinence. Insufficient hydration leads to harder stools and more difficult passage of intestinal contents, which is a significant risk factor for constipation in older adults.

Symptoms of Constipation

Constipation in older adults can develop gradually, and recognizing the symptoms and potential complications helps ensure timely action.

Main symptoms

  • Infrequent bowel movements (once every few days or less)
  • Small stool volume
  • Straining during defecation and a feeling of incomplete emptying
  • Bloating, cramps, dull pain in the lower abdomen
  • Reduced appetite, nausea, sometimes weight loss
  • In older adults, possible irritability, sleep disturbances, and worsening confusion (especially in dementia)

     

Possible complications

  • Hemorrhoids and anal fissures – prolonged straining increases pressure in the rectum, which can cause enlarged veins and painful tears of the mucosa
  • Rectal bleeding – resulting from damage to the mucosa or hemorrhoids
  • Diverticulitis – stool retention can cause inflammation of diverticula
  • Fecal impaction – a large, hard mass of stool becomes stuck in the rectum and cannot be expelled without medical intervention
  • Pelvic floor damage and rectal prolapse – intense straining can weaken the pelvic floor muscles and lead to prolapse of the rectum

     

Timely action, such as lifestyle changes or natural methods to ease bowel movements, can help prevent serious complications.

Preventing Constipation in Older Adults

Preventing constipation in older adults is based on healthy habits and reducing risk factors.
 The key measures include proper diet, physical activity, and regular bowel movement routines.

Adequate fluid intake


 Older adults should be regularly reminded to drink water. The goal is around 1.5–2 liters of fluid daily, provided their health allows it.
 An adequate amount of water helps keep stool soft and makes bowel movements easier.
 It is best to drink water throughout the day in small amounts.
 A glass of warm water in the morning on an empty stomach can help stimulate bowel function.
 Excessive intake of alcohol and caffeine should be avoided as they can dehydrate the body.

A diet rich in dietary fiber


 Fiber increases stool bulk and helps it pass through the intestines.
 It is recommended to include:

  • Fresh fruits and vegetables, whole grains, legumes, nuts.
     For those with chewing or swallowing difficulties, fiber can be consumed through soups, porridges, compotes (for example, prune compote), or dietary fiber supplements.
     Fiber intake should be increased gradually while ensuring sufficient fluid intake.
     Fatty, fried foods, red meat, and refined products should be limited as they slow digestion.
     Meals should be divided into several smaller portions during the day (for example, 5 small meals instead of 2 large ones).

     

Regular physical activity


 Movement stimulates peristalsis and strengthens the abdominal and pelvic muscles.
 Recommended activities include:

  • 20–30 minutes of walking daily, light stretching exercises, or tailored exercises for older adults.
  • Gentle activities such as gardening or light housework can also be helpful.
     For immobile individuals, circular abdominal massages in a clockwise direction can be applied.

     

Regular routine and avoiding postponement of bowel movements


 Delaying bowel movements increases stool hardness and the risk of impaction.
 It is important to establish a daily bowel routine, ideally in the morning after breakfast.
 The toilet should be easily accessible and adapted (raised seat, handrails).
 Getting used to such a routine may take time, but in the long run it helps maintain regular bowel movements.

Natural Remedies for Constipation in Older Adults

When treating constipation in older adults, the approach should go “from mild to stronger.” Natural methods are the first choice, while laxatives are used only under professional supervision.
 Most mild to moderate cases can be managed with home-based measures.

Diet and natural remedies – Dried fruits (such as prunes, figs, dates) and overripe bananas stimulate the intestines thanks to their fiber content and natural sorbitol. Warm drinks and herbal teas (chamomile, mint, ginger) aid digestion and reduce bloating, while senna tea should be used occasionally. A spoonful of olive oil or seeds (flax, chia) can soften stool, while probiotics, including yogurt with added psyllium, help regulate bowel transit.

Other natural methods – Glycerin suppositories can occasionally be used in acute constipation. A warm bath and relaxation techniques help relax the pelvic floor muscles and ease bowel emptying.

When to Use Laxatives for Constipation?

If natural remedies are not enough, laxatives may be prescribed under medical supervision. Osmotic laxatives help retain water in the stool, while stimulant laxatives speed up bowel movements, but they should not be used long term to avoid developing “lazy bowel syndrome.”

When to Seek Professional Help?

Constipation that appears suddenly in older age or persists for more than two to three weeks despite lifestyle changes may signal a more serious condition.
 Medical attention should be sought if:

  • stool contains blood or appears dark,
  • there are sudden changes in bowel rhythm,
  • symptoms include fever, severe abdominal pain, vomiting, or weight loss,
  • there are signs of complete bowel blockage or impaction.

     

In such cases, it is important to act promptly and seek professional evaluation.

Professional Care for Older Adults with Constipation

Chronic constipation in older adults often requires constant attention and a comprehensive approach. Families are sometimes unable to provide adequate nutrition, hydration, mobility support, and health monitoring on their own.

At Vila Košuta nursing home, a professional team of caregivers and medical staff takes care of all these aspects, regularly monitors residents’ conditions, and addresses constipation issues before they lead to complications.

In addition to a balanced diet and support with daily routines, our staff also oversees therapy management, since certain treatments can affect digestion. When necessary, we collaborate with specialists to ensure that therapies are tailored and safe.

Living in a care home helps older adults maintain healthy digestion, receive continuous support, and preserve their quality of life. For any additional information, please feel free to contact us.