Picture this: you grunt, you groan, you strain. Eyeballs, hernias, and hemorrhoids are bulging. Finally, an explosive passage of some hard and rocky material. You gingerly check for signs of blood.

If this sounds like a combat scene, think again. It may be the story of someone afflicted with constipation and bowel irregularity. Normal stool habits generally occur daily, though for some people, every two to three days is their natural rhythm.

Constipation may be a troubling and recurrent issue at any age, but especially so in the older adult. It can cause abdominal distention, pain, and even lead to concerns about obstruction such as from cancer. Constipation can be a result of multiple factors such as decreased fiber and fluid intake, inactivity, metabolic problems like low thyroid or low potassium, medications especially opiates, certain blood pressure and psychiatric drugs, loss of nerve function, decreased intestinal muscle tone, reduced gut elasticity, abnormal coordination of peristaltic contractions and relaxed, inefficient muscles in the pelvic floor and rectum.

Older adults often try a barrage of laxatives, bowel stimulants, stool softeners, lubricants, and even enemas to fight the wicked foe of constipation. Unfortunately, these can lead to laxative dependence, further worsening the situation.

For someone really blocked up, my favorite “blasting powder” is a 12-ounce bottle of magnesium citrate followed by 2-3 tablespoons daily of ground flaxseed to re-establish improved bowel habits.

A variety of herbs and supplements such as aloe vera, vitamin C, probiotics, and cascara can be useful as well as acupuncture. Biofeedback, hypnosis and other mind body therapies can be helpful in resistant cases.

I recall one patient who was totally obsessed with his constipation problem. He even bought an enema board that allowed him to treat himself over his toilet. This seemed like an extreme intervention but to him, at 91 years old, it was his most pressing health concern. He focused on this at every visit. Though he eventually died of natural causes, I know the distress of his chronic constipation was a significant one and strongly affected his quality of life.

So, to keep regular, be sure to do the following:

• Take adequate fiber in the form of fruits, vegetables, legumes, and whole grains. 25-30 grams of fiber daily is recommended.

• Maintain physical activity, at least 20-30 minutes of moderate exercise, such as brisk walking daily

• Drink plenty of fluids, for most people at least 64 ounces or more daily

• Consider supplemental fiber such as ground flaxseed or oat fiber

• Use stool softeners such as senna, docusate, suppositories, or even enemas if needed but discuss with your physician

While constipation is rarely life threatening, be aware of changes in your bowel habits and report these to your physician. Medications, iron, and dietary supplements can contribute to constipation. When in doubt, further evaluation including colonoscopy or imaging studies may be needed to rule out blockage or malignancy.

However, most cases respond to the lifestyle and dietary measures recommended here. Oh, and remember the classic prune juice. Though never studied in a randomized controlled trial, a simple test dose is proof enough for most people.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson family professor of integrative medicine and professor of family medicine at UTMB.

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