Bowel problems: What causes constipation?

Constipation refers to problems opening the bowels, straining on the toilet and infrequent bowel motions. Constipation can be stressful and difficult to manage. 

What is constipation?

It is important to remember that bowel habits vary considerably between individuals and what is considered a normal bowel pattern for one person will be different to the next person.

People with constipation can experience discomfort opening the bowels, the passing of hard dry stools and abdominal bloating.

Some people can become preoccupied with their bowel habits and worry over not passing a bowel motion every day. For most people constipation resolves itself. 

What causes constipation?

Constipation can also be a symptom of serious underlying disease or condition. Frail older people with chronic disease or recovering from illness are more likely to be at risk of constipation if they are experiencing prolonged bed rest, a change in diet and environment and use of some medication.

Constipation can be caused by:

• Lack of adequate fibre
• Not drinking enough fluids
• Lack of physical exercise
• Over use of laxatives
• Medications
• Acute illness, surgery or underlying disease
• Vaginal prolapse
• Gastrointestinal obstruction

Constipation can be serious if it leads to a blockage in the bowel. Sometimes this can be mistaken for diarrhoea as watery faeces leaks around the hard constipated stool high up in the bowel. This can happen after periods of prolonged bed rest such as hospitalisation or in people with dementia and can be a serious medical emergency. 

Prevention and management of constipation

Managing constipation is highly individual. People with constipation should always seek the help of a doctor as it could be related to medications or an underlying health condition.

Constipation can often be prevented by:

•  Eating more foods high in fibre
•  Drinking adequate fluids
•  Exercising and increasing physical activity
•  Understanding what medications may contribute to constipation
•  Going to the toilet after meals e.g after breakfast
•  Ensuring correct seating position on the toilet. Feet should be planted on the floor. Try using a foot stool or raised toilet seat
•  Ensuring privacy and time to sit on the toilet 

Tip

People with dementia may not be able to tell a carer when they feel constipated. Keep a record of a loved one's bowel habits, keep it handy near the toilet and be alert to signs of constipation like agitation, discomfort and poor appetite. Try blending prunes with water to make a pureed mixture to put on cereal daily.

References
Management of constipation in older adults
Accessed 2008, http://www.joannabriggs.edu.au/pdf/BP_Book_Vol12_7.pdf.