Constipation in older parents: how can family help?

Older adults get constipated more often than younger people. The US National Institute on Aging (NIA) names the main reasons as eating too few vegetables, fruits and whole grains, not drinking enough and not moving enough, along with some regular medicines. Parents with poor teeth often eat fewer vegetables and fruit because chewing is hard. Children and others in the household can help by planning everyday meals with vegetables, fruit and whole grains in easy-to-chew forms, encouraging drinks and walks, and making time for an unhurried toilet visit. If there is blood in the stool, bad tummy pain, vomiting or weight loss without trying, take them to a doctor.

The NIA says about a third of older adults have occasional symptoms of constipation, and that most of the time it is not serious. But many parents do not mention it to their children: some are embarrassed, others think it is just part of getting old. This article is for adult children and others caring for an older person at home. It covers why constipation becomes more common with age, how to notice it, how to plan everyday meals and routines, and when to see a doctor, using information from the NIA, the US NIDDK and the UK's NHS.

Why does constipation get more common with age?

The NIA says older people are more likely than younger ones to become constipated, and there is often more than one cause at once: eating, drinking, moving, medicines and health problems common at this age. The NHS also notes that constipation is common in people over 65.

Fewer vegetables and fruit, because chewing is hard

The NIA says not eating enough high-fibre foods such as vegetables, fruits and whole grains is one cause of constipation, and so is eating a lot of high-fat meats, dairy products and eggs, sweets, or processed foods. The NIA also notes that people with problems with their teeth or dentures often avoid meat, fruit and vegetables. A parent with poor teeth may end up eating rice porridge with salted egg or congee with shredded pork floss, which has very few vegetables.

Drinking too little

The NIA says not drinking enough liquids can contribute to harder stools that are more difficult to pass. Some parents drink less on purpose so they do not have to get up for the toilet so often, or simply do not feel thirsty, so it is worth noticing how much they actually drink each day.

Moving less, sitting or lying down for long periods

The NHS lists not moving enough and spending long periods sitting or lying down among the causes of constipation. The NIA also says lack of exercise, or long periods of inactivity because of illness or after surgery, can cause it. An older person whose knees hurt too much to walk, or who sits in front of the TV all day, becomes constipated more easily.

Changes in routine

The NIA says changes to the daily routine, such as travelling, can cause constipation. Moving in with a child in the city, a hospital stay, or several days visiting relatives upcountry changes waking times, mealtimes and toilets all at once.

Regular medicines

The NIA says some medicines, both prescription and over the counter, and some products taken as supplements can cause constipation. Many older people take several regular medicines. If you notice constipation starting after a new medicine, make a note and ask a doctor or pharmacist (see the medicines section below).

Other health problems

The NIA notes that many health problems common in older adults can cause constipation, such as problems affecting the muscles or nerves used for bowel movements, or problems affecting hormones. If constipation keeps going or comes with other symptoms, ask a doctor to look for the cause.

How can I tell if my parent is constipated?

The NIA says there is no right number of bowel movements: for some people twice a day is normal, for others three times a week. Signs that someone may be constipated include:

Many parents will not bring it up themselves. You might notice them spending longer in the bathroom, complaining of a bloated tummy, or eating less. Asking in a matter-of-fact way, for example over breakfast, "Have things been moving easily lately?", makes it easier for them to tell you than waiting for them to raise it. What matters is whether their habits have changed from what is normal for them, not how they compare with others.

My parent finds chewing hard. How can I fit vegetables and fruit into everyday meals?

For everyday eating, the NIA recommends fresh fruit and vegetables, cooked or raw, along with whole-grain cereals and breads. The NIDDK gives examples of foods with fibre: whole grains such as oatmeal, beans and lentils, fruit, vegetables such as broccoli and carrots, and nuts. The Thai Reference Daily Intake (Thai RDI) for dietary fibre is 25 grams a day for the general population aged 3 and over.

Choose forms that are easy to chew

For a parent who finds chewing hard, vegetables and fruit do not have to be hard and raw.

Add one meal at a time, so they get used to the taste and texture

If your parent has hardly been eating vegetables, start by adding one vegetable to one meal, then build up to other meals. Ask which vegetables they like and how soft they need them to chew comfortably; they are more likely to keep eating them than if the whole menu changes in one day.

If chewing is the problem, see a dentist

The NIA advises seeing a dentist if chewing is difficult, and if your parent wears dentures, the dentist can check the fit. Sorting out teeth problems helps them get back to a wider range of vegetables, fruit and meat.

For constipation in general, including when travelling, see What causes constipation, and how can I look after myself?

Besides food, how can I help with drinks, movement and toilet habits?

Encourage drinks through the day

The NIA recommends drinking enough water, juice and other fluids, alongside vegetables, fruit and whole grains. The NIDDK gives examples such as water, naturally sweetened fruit and vegetable juices, and clear soups. The NHS advises avoiding alcohol.

• Keep a glass or flask of water next to their usual chair.
• Include a clear soup at meals for both fluid and vegetables.
• If they worry about getting up for the toilet at night, encourage more drinks during the day and fewer in the evening, rather than drinking little all day.

Walk together

The NHS and the NIA both suggest walking regularly. The NIA suggests physical activity they enjoy, made part of everyday life: a morning walk around the neighbourhood, a trip to the market, watering plants, or a walk in an air-conditioned mall on hot days. If walking is difficult, getting up from the chair and walking around the house now and then is better than sitting for hours.

Make time for the toilet

• The NIDDK suggests trying to have a bowel movement 15 to 45 minutes after breakfast.
• The NHS suggests a regular time and place, with plenty of time. On busy mornings when you need to leave for work, do not make your parent rush to keep up with you.
• The NHS and NIDDK suggest resting the feet on a low stool on the toilet and trying to relax the muscles.
• A bathroom that is easy to reach, with grab rails and a non-slip floor, means they do not hold it in because they are worried about getting there.

For everyday meals, drinks and movement for older parents, see My older parents often feel unwell. What can we do each day?

Could my parent's regular medicines be causing constipation?

They might. The NIA says some medicines, prescription and over the counter, and some products taken as supplements can cause constipation. What you can do:

• Make a list of every medicine and product your parent takes regularly, including those bought without a prescription, and show it to the doctor or pharmacist at their next appointment.
• If constipation started after a new medicine, tell the doctor or pharmacist. The NIDDK advises not changing or stopping any medicine without talking with a health care professional.
• Before your parent uses any medicine or product for bowel movements, talk to a doctor or pharmacist. The NIA notes that a doctor can help decide what is suitable.

When should I take my parent to a doctor about constipation?

The NIA notes that constipation can sometimes be a symptom of a more serious health problem, and advises seeing a doctor if bowel habits change along with any one of the following:

• blood in the stool, or bleeding from the rectum
• serious stomach pain, or being unable to pass gas
• vomiting or fever
• weight loss without trying
• lower back pain

See a doctor too if constipation keeps going or is not getting better, and the NHS advises seeing a doctor if bowel habits change suddenly. Before the appointment, note how many times a week your parent goes, what the stools are like, what they eat and drink, and which medicines they take. This helps the doctor look for the cause.