Constipation in the Elderly Geriatric Care What is constipation? Constipation is difficulty in passing stools. Signs of constipation • Passing hard or dry stools • Fewer bowel movements than usual • Need to strain more to pas motion • Feeling of incomplete emptying, sometimes with watery stools What problems constipation cause? • Bloating • Discomfort • Pain in abdomen • Pain from excessive straining during bowel movements • Confusion and infections in frail elderly
Why do elderly persons develop constipation? 1. Lack of fibre and water in diet. 2. Not enough physical activity or exercise. 3. Changes in the environment that cause changes in routine of food and drink intake for example staying in a hospital or travelling overseas. 4. Certain medications that can cause constipation, for example some painkillers, blood pressure medication, iron and calcium supplements, and require the use of mild laxatives. 5. Ignoring the natural urge to have a bowel movement suppresses the natural function of muscles and nerves of the back passage. 6. Medical conditions, such as thyroid disease, diabetes, spinal cord injuries, growth of tumours or cancers that block the colon.
Practise the correct posture when passing motion •
Sit on the toilet bowl or bedside commode.
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Put your feet on the ground and push your body forward.
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You may need a footstool if your toilet seat is high or you are not very tall.
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Rest your forearms on your thighs.
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Close your mouth and breathe deeply to increase the pressure in your abdomen and push down.
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Increase your daily fibre intake by eating more fruits and vegetables, and cutting down on processed food.
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Moderate your intake of alcohol and caffeine, as these can produce more urine and increase water loss from the body.
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Keep active and exercise regularly.
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Pass motion in a private and comfortable toilet.
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Respond quickly to your natural urge to pass motion.
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Set aside time each day to pass motion and create routine.
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Practise the correct posture when passing motion.
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Pass motion at the same time everyday.
How to prevent constipation? •
Drink up to 8 to 10 glasses of water every day unless your doctor has advised you to limit your intake. Push body forward
Keep mouth closed Rest forearms on thighs
What should my stools look like? You can use the Bristol Stool Chart to check what your stools are telling you: •
Type 1 and 2 indicate constipation.
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Type 3 and 4 are ideal stools.
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Type 5, 6 and 7 may indicat diarrhoea.
When should I consult my healthcare professional? If you suffer from constipation, have a medical condition or take medications that can cause constipation, or have a change in your bowel pattern for more than 6 weeks, please ask your nurse or doctor for advice.
You should aim to have a stool consistency of Type 3 or Type 4 based on the Bristol Stool Chart. Bristol Stool Chart Type 1
Separate hard lumps, like nuts (hard to pass)
Type 2
Sausage-shaped but lumpy
Type 3
Like a sausage but with cracks on the surface
Type 4
Like a sausage or snake, smooth and soft
Type 5
Soft blobs with clear-cut edges
Type 6
Fluffy pieces with ragged edges, a mushy stool
Type 7
Watery, no solid pieces. Entirely liquid
Reproduced with kind permission of Dr. KW Heaton, formerly Reader in Medicine at the University of Bristol. ©2000-2014, Norgine group of companies
Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
GRM.PE.05.0419