Constipation is not a glamorous topic, but it’s certainly important, especially in older adults.
As anyone who has experienced occasional — or even chronic — constipation can tell you, it can really put a damper on quality of life and well-being.
Constipation can also cause more substantial problems, such as:
- Severe abdominal pain, which can lead to emergency room visits
- Hemorrhoids, which can bleed or be painful
- Increased irritability, agitation, or even aggression, in people with Alzheimer’s disease or other forms of dementia
- Stress and/or pain that can contribute to delirium (a state of new or worse confusion that often happens when older adults are hospitalized)
- Fecal incontinence, which can be caused or worsened by having a hard lump of stool lodged in the lower bowel
- Avoidance of needed pain medication, due to fear of constipation
Fortunately, it’s usually possible to help older adults effectively manage and prevent constipation. This helps maintain well-being and quality of life, and can also improve difficult behaviors related to dementia.
The trouble is that constipation is often either overlooked or sub-optimally managed by busy healthcare providers who aren’t trained in geriatrics. They are often focused on more “serious” health issues. Also, since many laxatives are available over-the-counter, some providers may assume that people will treat themselves if necessary.
Personally, I don’t like this hands-off approach to constipation. Although several useful laxatives are indeed available over-the-counter (OTC), I’ve found that the average person doesn’t know enough to correctly choose among them.
Also, although in geriatrics we often do end up recommending or prescribing laxatives, it’s vital to start by figuring out what is likely to be causing — or worsening — an older person’s constipation.
For instance, many medications can make constipation worse, so we usually make an attempt to identify and perhaps deprescribe those.
In short, if you’re an older adult, or if you’re helping an older loved one with health issues, it’s worthwhile to learn the basics of how constipation should be evaluated and managed. This way, you’ll be better equipped to get help from your health providers, and if it seems advisable, choose among OTC laxative options.
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