Tips to Manage Constipation in the Elderly with Dementia

Many people experience constipation due to changes in lifestyle, physical activity, travel, stress etc and that’s normal.  The issue is when it becomes chronic, so here are some tips to help manage constipation in the elderly with dementia.

In my my article ‘Constipation in the Elderly with Dementia’ we looked at what constipation looked like and the specific issues & factors facing families dealing with constipation & dementia 

Gut Motility

Gut motility is an important factor in being able to move waste products out of your system.  A number of factors can affect it like medication, hormone changes, diet, fluid intake, hormonal illness, diabetes, parkinsons, IBS, obstructions, nerve damage, weak muscles, thyroid issues and age etc.  All of these can affect the transit of food through your body.

If you have bloating, nausea, and physical stomach pain, then it may be related to IBS and you may want to avoid fibre rich, gas producing vegetables bulk forming solution. 

In most cases, managing constipation in the elderly with dementia is about improving slow transit issues, especially if you’re passing hard dry stools, and straining. We want to prevent getting painful piles (haemorrhoids), anal fissures or damaging the anal sphincter that control bowel movements.

So here are our tips to manage constipation in the elderly with dementia!

Fluids

Fluid, fluid, fluid, the number one thing you’re encouraged to increase if you have constipation.  That’s hard with someone who is worried about incontinence, or doesn’t feel thirsty or not remember when they last had a drink. 

Consider:-

• Keeping a jug of water near them, or cup of water on a side table next them to drink from
• Using two handed mugs if they have issues with dexterity
• Use cups with straws if they’re unable to hold them (careful if swallowing issues)
• Encouraging/reminding them to drink when you’re with them
• Add signage or use voice activated technology like Alexa, dementia digital clock to remind them to drink

Also, fluid doesn’t just mean just water. It also includes flavoured drinks, soups, shakes, tea/coffee, or choosing food types that are more laden with water like watermelon, berries. Try freezing fruits with high water content to make into slushies! But not milks or dairy products that can cause constipation.

Don’t Hold It In, Go When You Need To!

Your body is telling you that you need to go, by holding it in you risk it being reabsorbed & becoming dryer, constipated.  So if you have a routine then, don’t hold it in. Problems for those with dementia could be finding the bathroom or not understanding what the sensation means.

Consider:

• Making sure the bathroom is properly identified with signage or doors removed
• Distinguish the toilet seat colour from the toilet and surrounding colours
• Make sure to have easy clothing or adaptive clothing on to be able to pull down/undress to go once the urge hits
• Empty the water tank, disable the flush if you want to see the type of deposit and whether they have gone or use a urinal hat as a reminder to your loved one that you haven’t/or have gone that day.  (If you do this, make sure you explain why or have signage up to explain to them, otherwise it will be extremely confusing & irritating)
• Work together & use a poo chart to record when they’ve gone as a visual reminder, place somewhere near a clock/calendar to orient to day/time

Medication review

Your doctor or pharmacist will know best whether any specific drug is causing constipation like pain killers or whether a combination of drugs are causing constipation and be able to take action either to reduce dosage or swap to other types that don’t have these side effects.  So ask for a medication review. Also, ensure they review your vitamins as well. Be careful of vitamins like calcium and iron supplements that can aggravate constipation

Bowel Training

This is a useful tool for someone with dementia as the idea is to set up & establish a routine time to try to have a bowel movement.  Choosing the time should take into consideration your loved ones bowel evacuation normal timings

Consider:

• Setting up routines within 30 minutes of a meal as this is the best time to try when your colon will contract due to the gastrocolic reflex helping move food through your digestive system and increase the urge to have a bowel movement. 
• Setup reminders to try to have a bowel movement at an established time (with verbal encouragement from the dementia caregiver, or Alexa/Voice activated reminder, calendar, post its, whatever works for you)

Increase your Mobility

Increase your activity, walking, or any exercise helps reduce the time food spends in your intestines, reducing the possibility of your stools becoming dryer & the elderly more constipated. There are many active elders but there are some that also have other conditions like dementia, degenerating joints, who have reduced mobility.  

That doesn’t mean they can’t do any exercise.  Using encouragement, bring out old games that they enjoyed, adapting to suit their needs to increase mobility. This can improve their quality of life & support more regular bowel movements.  As a dementia caregiver that’s my goal! 

Consider:

• Joining exercise groups
• Using computer games like a Nintendo Wii to play active seated games, or follow along to standing exercises, use chairs to support you/keep balance
• Playing balloon badminton, throwing a ball, cushion, pass the parcel around (good for the core), using a door aerobic pulley system
• Light resistance with bands, light arm weights, leg lifts etc
• Seated exercises like Tai Chi, Yoga, or check out these gentle sitting exercises to help improve your mobility and prevent falls from the NHS.

There are numerous seated exercise video like these that you can do together this video below.

Fear of Falling

Fear of falling can play a massive part in the elderly with dementia.  Feeling dizzy, or off balance, swaying to one side, or leaning due to frailty or dementia balance issues mean you won’t be running to that toilet when you get the urge and may hold it till it subsides.  This can lead to dryer and harder stools which we want to avoid!

Consider

• Using walking sticks & walking frames
• Bring a commode into the bedroom to use in the mornings.
• Incontinence briefs, pads, and pant
• Installing grab rails in the bathroom

Self-abdominal Massage

Abdominal massage can help move stools – using gentle strokes to encourage stool movement can help with constipation in the elderly. You can do this for your loved one or they can try themselves, the site may be tender so be gentle. 

You can do 4 different types of massage to promote bowel movements: stroking, effleurage, kneading and vibration. This NHS leaflet describes the practice and the precautions as it’s not suitable if you have unstable spinal injuries, IBS etc.

Try doing it together and use a massage oil to help your hands glide over your stomach, I’m sure you’ll have a giggle doing this together (if the area isn’t painful)

If all else fails – Laxatives!

Laxatives can be used in conjunction with other measures to help constipation. You need to approach your doctor or pharmacist to prescribe the right type of laxatives for your constipation, and choosing the wrong one can make it worse. The most common form of laxatives are below

Types of Laxatives

If you have nerve damage or limited brain to gut connection, you will need some form of laxative to be taken.  This can be in the form of a stool softener, one that draws water into the colon or a stimulant type of laxatives.

If you’re feeling bloated or gassy, then you don’t want to be loading up on fibre-rich foods or using a fibre supplements, and avoid eating vegetables or food types like beans that produce a lot of gas.  You’ll probably need a stool softening laxative and increase of water intake.

You can also use suppository and enemas that are inserted into the rectum and work within 30 minutes, but consult with your doctor and ensure you’re able to use them correctly.  I had a district nurse demonstrate the correct positioning and insertion techniques to ensure my mum with Alzheimer’s was comfortable, reassured and remained calm.

Finally – Positioning – Squatty Potty!

I’m sure you’ve heard of the squatty potty, they had the best marketing campaign on how squatting is a more natural way to defecate.  The video below describes it better, and is fun to watch with your loved one!  But if you don’t have a footstool, you can use a pile of books to lift the knees above the hips and straighten your hips.

Word of caution here is that this doesn’t become a tripping hazard. I would advise that it only be used with the assistance of a dementia caregiver.

We also have issues where constipation occurs because food cannot be evacuated because of factors like prolapse, pelvic floor issues, and surgery or other remedies may be the answer in these cases. 

Let us know what works for you and your tips for managing constipation in the elderly with dementia.  In the next article, we’ll look at the best food options for helping relieve constipation.