April 13, 2011


My wife and I care for my elderly father at home, and he tends to be constipated. He’s sensitive to our asking about these matters, and we don’t want to embarrass him; yet I’m concerned that we take care of him properly. What should we do?
are of the elderly is a very rewarding and compassionate part of life, but not always easy. You’re giving your dad a secure place to live, but it does place demands upon you and your family.
One option is to inquire into available resources in the community, such as visiting nurse services. In dealing with sensitive health issues older folk may relate better to a health professional than to a family member, and these services will often permit you a little more free time as well. Otherwise, it might be helpful just to explain gently to your father that constipation can make him feel uncomfortable and that you only want to help.
2011 1510 page16As we age we may be given medications or supplements that tend to increase a risk of constipation. Calcium and iron supplements are common offenders, and some pain medications such as codeine can constipate. But there are simple approaches that may prevent constipation.
The old adage “An apple a day keeps the doctor away” may have special relevance to constipation. Of course, all fiber-rich foods are helpful in this regard. The “five a day” slogan popularized to encourage five fruits and vegetables a day is an excellent place to start. An apple, a carrot, an orange, a pear, a cluster of grapes, and a serving of greens such as broccoli or brussels sprouts are all highly recommended. Legumes are champions in the “fiber department.” Lentils, beans, peas, and whole grains all give substance that the bowels can get a “grip” on.

It’s also important to drink sufficient water or other fluid to keep the fiber soft and manageable by the bowel. The elderly sometimes need a reminder to do this. Some older folk may prefer a hot drink such as an herbal tea of chamomile or rooibos.
Taking time to sit and permit nature to do its work is very important. Regularity is encouraged.
Constipation, when severe, is referred to as obstipation. Great discomfort can follow obstipation, and seniors who are perhaps bordering on dementia can easily become confused and anxious if suffering vague discomforts. Paradoxically, if the constipation is severe and blocking the bowel, there may be apparent diarrhea, as lighter bowel content is squeezed past the obstruction. Cases have been reported of bowel obstruction leading to perforation and death. Residents of long-term care institutions have to be closely monitored for this problem.
Stool softeners such as docusate sodium or lactulose may hold fluid with the stool, thereby softening it and easing its passage. Senna may be used in standardized tablets to increase bowel motility. The giving of an enema requires the supervision of a health professional such as a nurse, because while a normal bowel tolerates an enema well, in the situation of possible bowel obstruction care must be taken to ensure the bowel is intact and not perforated.

Exercise assists in regular bowel action, and keeping your dad mobile will help many of his natural functions.
You are doing a wonderful thing, caring for your dad. Even though he may not thank you as much as you deserve, you will have the reward of knowing you have served and loved him well.
Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, MD 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.
Allan R. Handysides, M.B., CH.B., FRCPC, FRCSC, FACOG, is director of the general conference health ministries department.
Peter N. Landless, M.B., B.CH., M. MED., F.C.P. (SA), F.A.C.C., is ICPA executive director and an associate director of the general conference health ministries department. This article was published April 14, 2011.