Nurse Talk: Constipation in the Elderly
Anna, the eight-six year old patient I saw today told me that she takes a fiber pill with a glass of water twice a day and a stool softener once a day and yet she still doesn’t go regularly. I’m not surprised. Like many seniors, she also takes an iron pill for anemia, a pain pill for her arthritis, and a diuretic for her congestive heart failure. Each one of these meds can cause constipation. Her husband takes an anti-parkinson’s pill and an anti-depressant. His meds can also cause constipation.
It is not only medications that put seniors ar risk for constipation. They don’t drink enough fluids. Arthritis and other chronic illnesses keeps them from being physically active and physical inactivity slows the intestinal tract. Many of my patients don’t eat enough fresh fruit and vegetables. My eighty-six year old patient has a slice of toast for breakfast. Lunch is a bowl of soup with crackers. Dinner is often a frozen diet dinner heated in the microwave. That isn’t the kind of diet that will promote regular bowel movements.
I get to talk alot with my patients about what works and doesn’t work for them. One lady said eating a banana helps her. One man told me that eating a cup of cottage cheese usually works for him. And then there alot of seniors who swear that eating stewed prunes in the morning assures success. There is no doubt that some foods can stimulate bowel movements. I encourage people to do whatever works for them but I also make some suggestions.
I first talk to them about drinking enough water. That is a must if any other interventions are going to work. At least 6-8 glasses of water a day is the rule.
Senior citizens are at particular risk for dehydration because their kidney function has diminished to some degree. Symptoms of dehydration, which can cause death in extreme circumstances, include confusion, drowsiness, labored speech, dry mouth, and sunken eyeballs. Side effects for seniors who do not drink enough water, however, extend far beyond dehydration. Even short-term water deprivation has been known to cause chronic pain. Over time, lack of water causes loss of muscle tone, excess weight gain, slow metabolism, increased toxicity, and even organ failure. Other negative effects include arthritis, dry skin, migraines, hypertension, digestive complications, and persistent constipation.
I make sure their doctor is made aware of the problems they are having with their bowels. Any change in bowel habits can signal a serious illness so it is important that the doctor is kept informed.
I also tell them about a natural laxative they can make in their kitchens. Some time ago The Journal of Gerontological Nursing published recipes for “power puddings”. Patients like these recipes and find they work well.
½ cup prune juice
½ cup applesauce
½ cup wheat bran flakes
½ cup whipped topping
½ cup prunes (canned, stewed prunes)
Blend all ingredients, cover and refrigerate up to one week. Take ¼ cup daily with breakfast.
1 cup prune juice
1 cup bran cereal
1 cup applesauce
Blend all ingredients, cover, and refrigerate up to one week. Take two tablespoons daily.
2 cups bran cereal
2 cups applesauce
1 cup 100% prune juice
Blend all ingredients, cover, and refrigerate up to one week. Take 2-4 tbsp. a day.
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