Ah, the joys of aging—silver hair, wisdom, and, of course, the occasional constipation conundrum. As many of our other bodily systems decide to adopt a leisurely, retired pace, so do our esteemed bowels, leaving many seniors constipated and cranky (seriously cranky).  I’m telling you, bowel movements are a bit of a hot topic in the land of skilled rehab and long term care. Additionally, when paired with some hot and spicy hemorrhoids, the situation gets a little dicey. Fear not, dear seniors, for this article is your guide to conquering constipation and navigating the delicate terrain of those hemorrhoids so future interactions with your bowels are smoooooth sailing.

The slow dance of digestion–that infamous sluggishness in the bowel department–often becomes a familiar companion in our golden years. Blame it on decreased muscle tone, medications, or just the natural rhythm of life, but fear not—you’re not alone. According to the National Institute on Aging, constipation is a common affliction as we age.  Probably one of the most inconvenient and uncomfortable afflictions, and it can disrupt your entire day. 

So WHY do we slow down? Well, it happens for various reasons.  Some we can do something about, and some we cannot.  Let’s take a peek..

First and foremost, decreased smooth muscle tone and nervous system changes.  As you begin to experience decreased tone in many of your body systems, your colon is right there waiting to join in the fun! The muscles in the digestive tract, including the intestines, may experience a decrease in tone and strength with age. Furthermore, the nerves that innervate the bowel go through their own set of changes. This can result in slower, weaker contractions and movements, and changes to the coordination of the bowels in general, leading to a delayed transit of stool through the digestive system.  A traffic jam, so to speak.

Add to that natural changes in hormones that affect bowel function (especially women post menopause). Hormones play a role in regulating various bodily processes, and as these levels start to decline or shift, so too does bowel function. (Something to look forward to. Yikes)

Then we throw medications into the mix…older adults often take far more medications than your average healthy young adult and many of these medications directly impact bowel function. Certain drugs can lead to constipation as a side effect. Think medications for pain, bladder dysfunction, hypertension and certain supplements–like calcium and iron. There are also underlying health conditions that can directly affect bowel function–these should be managed by your friendly primary care provider or specialist!

Changes in dietary habits or a diet low in fiber can contribute to constipation. Fiber adds bulk to stool and helps promote regular bowel movements. Older adults may sometimes have diets that lack sufficient fiber. Appetite decreases and caloric intake suffers, so many elders may resort to eating things that are sweet or starchy just to get those taste buds firing, and often those choices do not have sufficient amounts of fiber, if any.  

As people age, their sense of thirst may decrease, leading to inadequate hydration. This can result in harder and drier stools, making them more difficult to pass. Pair that with certain changes to lifestyle–reduced physical activity–and this can contribute to a slower metabolism and decreased bowel motility.   Exercise stimulates the muscles of the digestive tract.  For those of you who have had dogs in the past (or currently)–how do you get them on a bowel regimen?  You take them for WALKS!  It gets their digestive juices flowing!

And last but definitely not least, the presence of hemorrhoids, whether internal or external, can psychologically impact the way we approach bowel movements.  We are all less hesitant to sit on the toilet if we know it will be painful! It makes us think twice when we have that urge to go, and we are more inclined to ignore it initially. This only creates more bulky and far more painful stools when we finally get down to business.

But here’s the thing.  You don’t have to simply just sink into a pit of self despair over this.  There are ways to tackle many of the issues that arise with aging. How do we make our bowels move more and with ease(but not too fast–let’s not invite the opposite problem!!!)?  Well, we first understand why we may be constipated in the first place—covered above.  Then we decide to make changes to the things we CAN change:

HYDRATE! Try for 64 ounces of water per day (if there are no other restrictions to your fluid intake!).  If you only reach ¾ of that goal, you are already ahead of most of the human population. Humans are terrible hydrators. (I am a terrible hydrator) 

Increase your fiber intake! Whole grains, fruits, and vegetables are your allies in this fiber-filled battle. The American Gastroenterological Association recommends a daily fiber intake of 25 grams for women and 38 grams for men, so load up on those fruits and veggies for a smoother digestive journey. If you struggle getting adequate fiber into your diet, there are a myriad of fiber supplements at your local walgreens, CVS, etc.  I am pretty sure there is an entire section dedicated to bowels (which proves constipation really is a “thing”) Be careful not to confuse fiber supplements with laxatives–the goal is to improve transit, not accidentally prep for a colonoscopy! Side note–you should absolutely talk to your healthcare provider if you have not had a screening colonoscopy. I’m gearing up for mine this year!

Increase your physical activity!  A brisk walk or some light aerobics can stimulate bowel movements and keep your digestive system in tip-top shape. Get moving, and your digestive tract will thank you with a dance of its own. (Take that dog for a walk–you can work on bowel health as a team 😁)

Hemorrhoids…treat the terminal end of your GI tract with a little TLC if you suffer from these.  To ease the discomfort, try warm baths, topical creams, and donut-shaped cushions to relieve pressure. If these prickly engorged blood vessels are particularly troubling, a gentle stool softener (docusate or senna) may help reduce pain during the passage of stool.  Again, not a laxative!  If symptoms persist, consult your healthcare provider for personalized advice. And as I always say (it’s exhausting but I do have to say it!) a blog does not take the place of your trusted health care provider who knows you in person and not through the internet! 

So go forth and arm yourself with the tools to face constipation and/or hemorrhoids head on….or butt forward?  Fiber, hydration, exercise, self-compassion, humor and evidence-based knowledge can help you reclaim control over your digestive destiny.  My wish for you is that constipation becomes no more than a passing inconvenience!  Happy bowel evacuation, seniors!