Managing Constipation in Seniors: Causes, Solutions & Diet Tips

Constipation in older adults is common (20–30%) but not inevitable. Multifactorial etiology requires tailored approach.

Common Causes

• Low fiber/fluid intake.
• Reduced mobility, sarcopenia.
• Medications: opioids, anticholinergics, calcium channel blockers, iron, antacids (Al/Ca), diuretics, antidepressants (TCA, SSRI), antipsychotics.
• Comorbidities: hypothyroidism, Parkinson's, diabetes, CKD, depression.
• Pelvic floor dyssynergia.

Stepwise Management

1. Lifestyle: Fiber 25–30 g/day (gradual increase), fluids 1.5–2 L/day, scheduled toileting (post-prandial), mobility.
2. Medication review: Deprescribe constipating drugs; switch alternatives.
3. Osmotic laxatives (first-line): PEG 3350 17 g/day (safe, effective, non-habit forming). Lactulose (may cause bloating).
4. Stimulant laxatives (add-on): Senna, bisacodyl — short-term/rescue.
5. Secretagogues: Linaclotide, plecanatide (IBS-C/CIC).
6. Prokinetics: Prucalopride (chronic idiopathic constipation).
7. Rescue: Enemas (tap water, phosphate), suppositories (bisacodyl, glycerin) — fecal impaction.

Prevention

• Fiber + fluid + movement daily.
• Bowel diary.
• Annual medication reconciliation.

Key Takeaway

Constipation in seniors is manageable: optimize fiber/fluids/mobility, review meds, use PEG as first-line chronic laxative, escalate stepwise. Avoid chronic stimulant dependence.