What causes constipation in older adults and how to treat it

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According to the National Institute on Aging, people differ in how regularly they have bowel movements. Having “regular” bowel movements simply means that bowel movements occur at a frequency that is normal for that individual. If a person experiences infrequent bowel movements, they may have constipation.

Around one in three older adults experiences occasional symptoms of constipation. These may include:

• producing fewer than three bowel movements in a week
• having difficulty passing stools
• producing lumpy or hard stools
• experiencing a sensation of having blocked bowels or not having fully emptied the bowels

The following sections describe the three main causes of constipation in older adults.

Medical conditions

Medical conditions that may cause or contribute to constipation include:

• disorders affecting the nerves or muscles necessary for bowel movements, such as:
  • stroke
  • Parkinson’s disease
  • spinal cord injury
• diseases that can affect a person’s diet or daily habits, such as Alzheimer’s disease or other types of dementia
• conditions affecting the hormones or metabolism, such as diabetes
• pelvic floor disorders
• gastrointestinal disorders, such as irritable bowel syndrome
• tumors and other blockages in the bowel

Medications and dietary supplements

Some over-the-counter (OTC) and prescription medications can cause constipation. Examples include:

• some pain relievers
• antacids containing aluminum or calcium
• some medications to treat high blood pressure
• diuretics
• certain antidepressants
• certain antihistamines
• anticholinergics
• antispasmodics
• anticonvulsants
• drugs to treat Parkinson’s disease
• anesthetics

Dietary supplements containing iron may also cause constipation.

Lifestyle factors

The following lifestyle factors may increase a person’s risk of constipation:

• not eating enough high-fiber foods, such as:
  • vegetables
  • fruits
  • whole grains
• eating too many high-fat meats, dairy products, eggs, sweets, and processed foods
• not drinking enough fluids, which may make stools hard and difficult to pass
• changes in routine, such as traveling
• not getting enough physical activity

Learn more about foods that can cause constipation.

Older adults can try the following home remedies for constipation:

• eating three meals per day and avoiding skipping meals
• increasing intake of fiber-rich foods gradually
• drinking 6 to 8 glasses of water per day
• limiting or avoiding highly refined and processed foods
• exercising regularly and including walking or other weight-bearing exercises three or more times per week
• going to sleep at the same time each night, and getting good quality sleep
• managing stress

If home remedies do not help, a person may want to consider OTC or prescription treatments.

A 2020 review outlines some common treatment options for chronic constipation in older adults. These include:

• Osmotic laxatives: These medications draw water into the stool, helping to soften the stool and ease its transit through the digestive tract. Osmotic laxatives may take 2 to 3 days to take effect. Examples include:
  • lactulose
  • macrogel
  • polyethylene glycol
  • magnesium citrate or magnesium oxide
• Stimulant laxatives: These medications stimulate the muscle lining the gut, helping move stools through the digestive tract. They take 6 to 12 hours to work. Examples include bisacodyl and sodium picosulfate.
• Suppositories and enema: Anal suppositories and enema can help to alleviate constipation and prevent fecal impaction in older people with impaired mobility. An enema involves inserting liquid directly into the rectum to stimulate defecation. According to a 2020 review, doctors generally recommend water-based enemas for older individuals, as these are safer than phosphate-based enemas.
• Prokinetic agents: These medications help stimulate the gastrointestinal tract, helping move stools through the colon. An example is prucalopride, which doctors may prescribe when other laxatives are ineffective.
• Lubiprostone: This medication increases the secretion of intestinal fluids, and improves stool transit through the colon.
• Biofeedback: This training practice helps train the muscle functions necessary for regular bowel movements. Biofeedback incorporates visual and auditory input that helps people learn more effective techniques for passing stools.

The United Kingdom’s National Health Service (NHS) offers the following tips on helping to prevent constipation:

• Making dietary changes: To soften stools and ease their passage through the colon, people can:
  • eat foods rich in sorbitol, such as apples, apricots, and strawberries
  • add wheat bran, oats, or linseed to the diet
  • drink plenty of water and other fluids
  • avoid alcohol
• Improving the bathroom routine: The following tips can help prevent constipation:
  • keep to a regular toileting schedule as much as possible
  • ensure plenty of time to use the toilet
  • avoid delaying the urge to empty the bowels
  • rest both feet on a low stool while using the toilet, and raise the knees above hip level if possible
• Increasing activity levels: Daily walking or other forms of exercise can help stimulate the bowels, resulting in more regular bowel movements.

Read more about foods that help with constipation.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a person experiencing constipation should see a doctor if their symptoms do not improve with home remedies or if they have a family history of colon or rectal cancer.

If constipation does not improve following treatment, doctors may recommend additional tests to see if there is an underlying issue.

The NIDDK adds that a person should see a doctor immediately if they experience constipation alongside any of the following symptoms:

• bleeding from the rectum
• blood in the stool
• inability to pass gas
• persistent abdominal pain
• lower back pain
• vomiting
• fever
• unexplained weight loss

Constipation is common among all age groups but especially among older adults. Symptoms include having less regular bowel movements than usual, difficulty passing stools, or incomplete bowel emptying.

Medical conditions, medications and supplements, and lifestyle factors, such as a poor diet and insufficient exercise, are common causes of constipation in older adults.

People with constipation may benefit from gradually increasing their intake of fiber-rich foods, drinking more fluids, and exercising regularly.

If home treatments do not help ease constipation, a person can talk with a doctor or pharmacist about laxatives and other treatment options. Anyone who continues to experience chronic constipation should see a doctor to determine the cause.