Perhaps it’s not polite conversation, but it’s likely top of mind for many. How else to say it but- do you have trouble pooping? While there’s no one right pattern for everyone, generally speaking, if you go less frequently than 2-3 times per week or you have difficulty with hard stools, you may have a constipation problem. And experts suggest that if the problem lasts more than 3 weeks or you’ve gone without a bowel movement for more than 4 days, you’re best off contacting your physician. However, what’s normal for you may be quite different for someone else. In fact, did you know that even if you go every day you can still be considered constipated if you had to strain to eliminate your movement or you don’t feel completely empty? It’s thought that chronic constipation affects up to 40% of adults aged 60 and above, so if you’re suffering, you’re definitely not alone. For some general overviews of the problem, close the bathroom door and click here and here.

While in most cases constipation poses little risk of serious or life-threatening harm, the reality is that it can cause physical or mental distress and may get in the way of social engagement if you’re uncomfortable leaving your home. (There’s also a whole separate issue of being uncomfortable pooping in a public place, which is called parcopresis, which may also lead you to refrain from social outings.) The good news is that in most circumstances, changes in diet and more physical activity can improve your situation, along with the use of laxatives, which are not dangerous to regularly use, as long as you understand the way they work and what you should avoid. And for that, we should consult the wisdom of expert geriatrician Leslie Kernisan, whose article, How to Evaluate, Prevent & Manage Constipation in Aging, is essential reading for anyone dealing with this issue. 

In a nutshell, here’s the message that Dr. Kernisan delivers when it comes to constipation: In most circumstances, it can be prevented or well managed in older adults, provided you are open to discussion to determine the causes and to embrace proposed solutions. (Remember, however, that those with cognitive impairment may not be able to vocalize the problem and instead may display their discomfort through agitation or acting out). In order to evacuate stool, it needs to move through your colon into your rectum. As you get older, this may be harder to do for many reasons, including side effects from medications you take, insufficient fiber or water in your diet (which help move stool along), nerve or pelvic floor dysfunction, low physical activity, or other physical or psychological factors. You should know that many commonly used drugs, including opiates, diuretics, and iron and calcium supplements are associated with constipation.

As for treatments, Dr. Kernisan advises lifestyle changes- like diet revamps and increased exercise, along with over-the-counter laxatives, which she does not hesitate to suggest if you are having problems. Regarding diet, all experts suggest you need to eat enough, and you need to eat the right kinds of whole foods, especially fiber. Beyond the fruits, veggies, nuts, beans and whole grains that should be a part of everyone’s healthy diet, those who are constipated should also be sure to up their fiber intake, though you are advised to do so gradually so as not to jolt your system too quickly. Specifically regarding fiber, learn the differences between insoluble fiber (like wheat bran) and soluble fiber, which usually includes psyllium, the key ingredient found in Metamucil. 

And one other newly discovered item to add to your menu if constipation is a concern? New research suggests kiwifruit, in combination with prunes and psyllium, can effectively relieve symptoms of chronic constipation. Find out more by reading here. Bottom line? Few of us should be suffering the consequences of constipation- in most cases, it’s a manageable and addressable problem once you have the conversation.