Dealing with chronic constipation – The Washington Post

• You have fewer than three bowel movements per week.
• You need to strain for at least a quarter of all your bowel movements.
• Stool is often hard or lumpy.
• Sometimes you feel like your bowels haven’t been fully emptied.

For relief, people with chronic constipation may turn to laxatives.

“Many older adults assume that constipation is just another inevitable part of aging, but it can be avoided through lifestyle [strategies and] occa­sion­ally medication,” says Christian Stevoff, a gastroenterologist at Northwestern Medicine in Chicago.

Know the causes of chronic constipation

Chronic constipation might be more common in older adults, affecting about 26 percent of women and 16 percent of men over age 65, and 34 percent of women and 26 percent of men older than 85, according to a 2021 study.

“As we age, our gut and nervous system also age, and one of the consequences of that is the degeneration of nerves and muscles (that move waste along) so that they don’t function as well as they used to,” says Satish Rao, chief of gastroenterology at Augusta University in Georgia.

But other factors, includ­ing insufficient fiber and too little physical activity, can also contribute. Medications such as opioids and certain antidepressants, blood pressure meds and Parkinson’s disease drugs are all potential culprits, Stevoff says.

Some over-the-counter (OTC) pain relievers, such as ibuprofen and naproxen, are also associated with constipation, and supplements that contain calcium or iron “can bind you up,” says William Chey, a gastroenterologist at the University of Michigan in Ann Arbor.

Hypothyroidism or neurological issues such as multiple sclerosis can lead to constipation, too, as can pelvic floor disorders — which affect the ability to coordinate muscles to push stool out, says David Poppers, a gastroenterologist at NYU Langone Health in New York.

Try these lifestyle steps

Lifestyle strategies can be quite effective if you continue them, but they can take several weeks to begin working. If you need immediate relief — for example, you haven’t passed stool in several days — you might consider using an OTC osmotic laxative with polyethylene glycol (PEG), Stevoff says. (For some, stimulant laxatives, such as senna and bisacodyl, may have harsher side effects than PEG-based medications.)

Always let your doctor know if you haven’t had a bowel movement in several days. For the long haul, try these strategies:

• Increase your fiber. It helps bulk up stool, making it easier to pass. Research suggests that eating five or six prunes each day is as good for chronic constipation as some laxatives, Rao says. Or try eating two kiwi­fruits a day; Chey’s research finds that it relieves constipation in about half of people, without some of the side effects of prunes, such as abdominal pain, bloating and gas.
• Ramp up your fiber intake. Try this over a period of days to weeks to allow your body to get used to it, Chey says. If you find it hard to get enough fiber through food, consider taking an OTC fiber supplement. The best evidence is for those that contain psyllium, Poppers says.
• Drink enough fluids. Try to drink about eight 8-ounce cups of fluid every day. A cup of coffee might also be helpful because it’s a mild gastro­­intestinal stimulant. Many older adults are perpetually dehydrated, which can worsen constipation, Chey says.
• Pay attention to timing. Your bowels tend to be most active within about a half-hour after a meal, so make sure you have access to a toilet then. It’s fine to spend about five to 10 minutes in the bathroom, but if nothing happens in that time, try later in the day, Poppers says.
• Adopt the right posture. You want to keep your knees above your hips, which relaxes pelvic floor muscles that loop around the back of your rectum, says Carrie Pagliano of the American Physical Therapy Association. “This way it provides a straight shot for BMs to go out,” she says. One option is to sit on the toilet with your feet on a small footstool, such as the Squatty Potty. And avoid straining­.
• Exercise. A 2017 study found that women with chronic constipation who walked on a treadmill for 60 minutes three times a week for 12 weeks reported an improvement compared with a control group.

If you need long-term help

If you’ve tried lifestyle changes for three to four weeks and still experience some chronic constipation, see your doctor, Stevoff says. A physician can do bloodwork to rule out medical conditions, review your meds and supplements, and, if necessary, perform tests such as a colonoscopy to check for an obstruction or a blockage. If your chronic constipation is caused or worsened by pelvic floor problems, your doctor may recommend pelvic floor physical therapy, where you’ll learn techniques such as abdominal massage that can help get things moving again.

When there’s no clear cause, Rao says prescription medications could be an option — temporarily or in some cases long-term.

When the problem becomes severe

If your constipation is unresolved for too long, it can lead to fecal impaction, where a lump of dry, hard stool becomes stuck in the rectum.

In addition to constipation, this can bring abdominal pain and a feeling of fullness that affects appetite. Fecal impaction can also lead to diarrhea, because of watery stool from higher up in the gastrointestinal tract passing around stuck stool, Rao says.

A doctor can diagnose fecal impaction with a digital rectal exam and X-rays. They may try to remove the impaction manually or administer a warm-water enema to flush it out. If it doesn’t respond to these measures, or if your doctor sees signs of a perforated colon, you might need emergency surgery.

Once the stool is removed, your doctor will recommend a laxative or other steps to prevent a recurrence, such as increasing fiber intake and staying active. You’ll also want to talk to your doctor about medications that may contribute.

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