When was your last bowel movement?

That’s not a very pleasant greeting, is it? But it was one of the first questions I was required to ask all of my newly admitted patients in long-term care. We were required to keep a daily record of bowel function. Your doctor probably asked you a similar question – such as, “Are your bowels regular?” during your last check-up. Mine did, and I am glad to tell you that I could answer, “Oh, yes!”

During the recent holidays, when I visited some of my favorite caregivers, constipation ended up being a popular subject. That suggested to me that maybe it was time to talk about bowel movements (or lack of them) in this blog.

As a caregiver, it is important to be aware of your loved-one’s bowel health, especially if they are bed-ridden or have dementia or other serious health concerns. The goal is to avoid constipation, which is defined as: bowel movements that are infrequent (normally less than three per week) or hard to pass. Constipation is a fairly common concern in older adults, but left untreated it can lead to impaction, which can lead to bowel obstruction that can be life threatening. 

It is a good idea to keep a record or “toileting chart.” A sheet of paper taped to the back of the bathroom door is convenient for this purpose. A change in normal bowel habits, going four or more days without a stool, or unusual pain in the abdomen or rectal area should alert you to contact your recipient’s health care provider.

Constipation has several causes, with a poor diet being the most common (especially when that is accompanied by little or no physical exercise.). One of my patients ate like a bird but worried about being constipated if she didn’t “go every morning.” I reminded her that “what goes in comes out” and that if she barely ate, she could not expect to eliminate (no rhyme intended). Eventually, she accepted that three movements a week was normal for her circumstances.

The caregiver I spoke to recently (both she and her husband are in their eighties’ and he is in the middle stage of Alzheimer’s) was concerned that her husband was going three to four days without a bowel movement, although when he had one, it passed easily. I asked her about his eating habits. She chuckled, and then admitted that about all he really liked to eat was chicken nuggets and French fries. 

A diet that helps to prevent constipation includes one rich in fiber (whole grains, fruits and vegetables) and low in animal fats and refined sugar. Fast food fare such as chicken nuggets and French fries is the antithesis of a bowel-healthy diet. Frail or sickly older folk often lose their appetite – and sometimes you just have to reluctantly let them eat what they will. But, oh, please, do encourage them to eat foods that are good to them and for them. You may have to experiment, use new techniques (such as blending various fruits into a smoothie) and gently coax, but they will feel so much better if their digestive system is running smoothly.

Inadequate fluid intake also contributes to constipation. Because fluid is absorbed in the intestine, consuming too little can cause hard stools that are difficult, even painful, to pass. A side effect to straining to defecate is hemorrhoids; so a little prevention is definitely worth the cure. Provide and encourage plenty of liquids – particularly water.

I have been proclaiming this fact for years and the other day I heard a doctor declare it on television (so of course it is true – wink): Water is the perfect beverage. It truly is and should be the beverage of choice for ourselves and our loved ones. One of my proudest achievements of this past year is that my grandkids are requesting water more than any other beverage. Of course, they probably know by now that is Grammy’s beverage of choice and what they will get when they tell me they are thirsty. Sometimes I slice citrus fruits (lemon, lime, orange) into water and they really seem to enjoy that. 

We sometimes forget that water is one of the six essential nutrients our body needs for optimal health (along with proteins, fats, carbohydrates, vitamins and minerals). Not only is water the means the body uses to flush out waste products, but it also prevents the buildup of uric acid, the leading cause of gouty arthritis. While our bodies have to work to process the artificial ingredients in sodas and the tannic acid in tea and coffee (a waste product that inhibits the body’s absorption of iron), water requires no effort from the body to metabolize or excrete. It is best to avoid caffeinated and alcoholic beverages, both of which work against hydration. 

Lack of exercise is another common cause of constipation. If your receiver is physically able, encourage as much activity as possible, especially walking. If your receiver is bed-ridden, then you must be even more vigilant to monitor bowel function.

Since poor bowel habits (such as resisting the urge) can also lead to constipation, it is helpful to establish a routine. Suggest a visit to the toilet at the same time each day. Some people prefer to go first thing in the morning; others feel the need just after a meal. If you enjoy the privilege of being able to take your loved one on outings, plan ahead and encourage him or her to go before you leave. It’s also a good idea to be aware of the availability of bathroom facilities when you are out and about.

It is probable that the person you care for takes several medications and some of these may contribute to constipation. Antacids that contain aluminum hydroxide and calcium carbonate; antidepressants; diuretics; iron tablets and especially narcotic pain medications are just some of the culprits. If you have any concerns about the relationship of medications and bowel function for your recipient, discuss these with your pharmacist or health care provider.

While laxatives can produce helpful (though sometimes harsh) results when truly needed for occasional episodes, using them habitually may lead to dependency. Following the above guidelines may eliminate the need for over-the-counters stool softeners and laxatives. A good goal to aim for is at least three, soft, formed bowel movements a week.  Someone with a healthy, normal appetite can be expected to have a bowel movement most days. 

 As I was researching this topic, I came across a “position to defecate” which was new to me but I thought might be helpful for someone who has difficulty or strains during a bowel movement. It involves adopting a “semi-squatting” position, which can be achieved by using a footstool and leaning forward on the toilet. 

Additional interesting information concerned the effect of regular bowel movements in preventing colon cancer. When you follow good nutrition guidelines that contribute to regular bowl function (eating lots of fiber and drinking lots of water), waste exits the body more quickly. This decreases the impact of cancer-causing agents in food on the bowel walls. 

This is a good time to also consider your own bowel habits and make any needed changes in your habits. A synopsis of good bowel health seems to indicate that constipation can best be addressed by increasing the daily intake of dietary fiber and water. Choose whole grains, fresh fruits, vegetables and legumes  – all great sources of fiber (what our moms used to call roughage). Make water your beverage of choice and drink at least eight glasses a day. Staying active is a plus.

I will close today’s topic with a motto from one of those really creepy toilet paper commercials: “Enjoy the Go!”