Caregiver's Home Companion

Posted: July 31, 2006

Are Laxatives and the Elderly
a Necessary Evil?

Laxative use and aging seem to go hand in hand.  An estimated 75% of elderly residing in hospitals or nursing homes use laxatives to regulate bowel function.  And the high level of laxative use in the elderly population isn’t limited to healthcare facilities: in a survey of more than 4,000 elderly by Duke University, laxative use was found to be common in the home and was related to specific factors concerning family practices, health status, and access to health care.


It shouldn’t be any surprise that elders and their caregivers turn to laxatives for a solution to constipation.  And, as a result, business is booming. There are approximately 700 commercially available products touted to relieve the symptoms of constipation, many of which are regularly advertised in the media.  But health experts are concerned that elderly dependence on laxatives has turned into laxative abuse rather than use. 

Drive Longer, Stay Independent

Recent studies also have raised concern that the elderly population too frequently receives inappropriate medical care and drugs that are not supported by a clear need.  Sometimes, according to these studies, it may be that a physician turning to a prescription pad to order laxatives might be the easiest solution to treating constipation. 


Chronic use of laxatives has been associated with many problems, such as diarrhea, fecal soiling, hypoalbuminemia, and high serum levels of magnesium and phosphorus.  The Nutrition Health Review reported that the heavy use of laxatives has created long-term laxative abuse, a condition that might lead to nutrient deficiencies, metabolic disorders, and potentially severe damage to the gastrointestinal tract.


Chronic laxative use also can injure the nerves and muscles of the colon, leading to a condition known as megacolon, where the colon becomes flabby and unable to push along fecal material.


Defining Constipation


The elderly often turn to laxatives without fully understanding constipation, which is defined as a condition in which stools are too small, too hard, too difficult to pass, or are infrequent (less than three per week).  Researchers have identified these risk factors for constipation: older age, African-American, female, poor socio-economic status, less exercise, less education, and low calorie intake.  But contrary to popular opinion, constipation does not have to be an automatic consequence of aging.


Constipation is frequently caused by inadequate dietary fiber or fluids, medication side effects, emotional or physical stress, lack of activity, certain medical conditions, or simply a poor understanding of normal bowel habits. 


Medications that can cause constipation include antacids, anticholinergics, antidiarrheals, antiparkinsons, antidepressants, antihypertensives, antiarrhythmics, metals (bismuth, iron, heavy metals), opioids, NSAIDs, and sympathomimetics.  Medical conditions that might have side effects of constipation include colon cancer, underactive thyroid, overactive parathyroid, depression, dehydration, scleroderma, Parkinsonism, stroke, and diabetes. 


Constipation can also happen when patients are hospitalized due to extended bed rest, lack of exercise, and change in food and fluid intake. 


Non-Laxative Solutions for Constipation

Before you turn to over-the-counter laxatives to solve a constipation problem in an elder, try alternative methods.  Start by scheduling an appointment to discuss constipation with the doctor.  Pain, fever, urinary or fecal incontinence, diarrhea, or delirium may occur with prolonged constipation or fecal impaction, so it is best to deal with constipation head on rather than ignoring it.  

Also, it may help to keep a journal of bowel habits, including stool frequency, consistency and straining.  If an acute episode of constipation occurs, you may need to see a physician immediately.  For battling chronic constipation, many solutions may prove effective.  But searching out the root of constipation, from medications to medical conditions, is an important first step.

Eating to Avoid Constipation

Changing diet to increase fiber and fluids is also a very effective method of combating constipation.  Strong epidemiologic evidence has shown that greater amounts of dietary fiber are associated with a lower prevalence of constipation and other gastrointestinal disorders, including diverticular disease and colorectal cancer.  Fiber appears to do its work by increasing stool bulk and weight and by speeding intestinal transit time.  Current recommendations suggest that adults consume 20-35 grams of dietary fiber per day, but the average American eats only 14-15 grams of dietary fiber a day.  Fiber supplements in the diet, such as added bran, can further increase fiber intake.  

In addition, it is important to increase the intake of fluid along with fiber.  The recommended daily requirement for water or non-caffeinated fluids is eight 8-oz glasses, assuming that the individual has no cardiac or renal problems that may prohibit this amount of fluid.  Try to make sure meals are eaten on a regular basis and that foods are chewed well.  Encourage your loved one to have regular bowel movements, taking advantage of particular times of the day, such as immediately after breakfast, when the body has a natural gastrocolic reflex for elimination.  Encourage your senior to never resist or postpone the body’s urge to have a bowel movement.  And don’t forget to include regular exercise in their daily routine. 

Sometimes, when all attempts to solve the constipation problem have failed, it may be necessary to turn to laxatives as a last resort.  But rather than self-medicating your loved one, create a plan with your healthcare provider that combines complimentary care through diet and exercise along with a laxative program, takes into consideration possible side effects of laxative medications, and implements a long term plan to resolve constipation.  Your loved one will be healthier and happier for it. 


Sharon Palmer is a registered dietician with 16 years experience managing healthcare food and nutrition departments. Her career has included clinical nutritional care for a broad spectrum of patients, from eating disorders to elderly. She also has managed the food and environmental services departments in several acute care hospitals. Ms. Palmer lives in Southern California.

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