Constipation (Older Adults) — UK Information Guide

Important: When to seek urgent help (999 / NHS 111)

What is constipation?

Constipation means passing stools less often than usual, difficulty or straining when opening your bowels, or stools that are hard, dry, or lumpy. Many older adults pass a comfortable stool every 1–3 days; some go less often without problems. Focus on comfort, ease, and your personal pattern rather than a fixed number.

Common causes in older adults

• Low fibre / low fluids or irregular meals.
• Reduced mobility or long sitting/bed rest.
• Medicines: opioids (e.g., codeine, morphine), anticholinergics (e.g., some bladder, allergy, antidepressant tablets), iron tablets, calcium supplements, some blood-pressure medicines, antacids with aluminium, some Parkinson’s drugs.
• Medical conditions: diabetes, hypothyroidism, high calcium, Parkinson’s disease, prior stroke, cognitive impairment, depression, IBS-C, pelvic floor problems (e.g., rectocele), prolonged ignoring of the urge.
• Pain, toileting barriers, or embarrassment (e.g., access, lighting, lack of privacy, unfamiliar toilets).

Related reading: IBS (irritable bowel).

Safe self-care & bowel routine

These habits are safe for most people and often reduce the need for medicines:

• Toilet position: sit with knees above hips (use a small footstool), lean forward with straight spine, rest elbows on knees, breathe and relax the belly; don’t hold your breath.
• Timing: sit on the toilet after breakfast or a hot drink; allow 10 minutes without straining.
• Movement: gentle activity (e.g., short walks, chair exercises) stimulates the bowel.
• Regular meals: include fibre-rich foods daily; avoid skipping meals.
• Fluids: sip regularly across the day unless a clinician has set a fluid restriction.
• Respond to the urge: don’t delay if you feel the need to go.
• Review medicines: ask your pharmacist/GP if any tablets may be worsening constipation.

Diet, fibre & fluids

• Build fibre gradually to reduce wind/bloating. Aim for a varied mix of soluble (e.g., oats, pulses, fruit) and insoluble fibre (e.g., wholegrains, veg skins) if tolerated.
• Everyday ideas: porridge with fruit; wholegrain toast; beans/lentils; vegetables with skins where safe; a handful of nuts (if safe to chew/swallow).
• Prunes/prune juice: can be effective for many; start small and adjust.
• Fluids: water, milk, tea/coffee, soups all count. Many older adults benefit from ~6–8 drinks/day unless advised otherwise.
• Fibre supplements (bulk-forming) can help some people, but only if fluid intake is adequate and you can stay mobile. Avoid if you have faecal impaction, very poor fluid intake, or swallowing difficulties.

If you have kidney/heart problems, swallowing difficulties, or are on a fluid restriction, ask your GP/pharmacist for tailored advice.

Medicines & laxatives (overview)

Speak to a pharmacist first — they can advise safe options with your medicines. General principles in primary care often include:

• Osmotic laxatives (e.g., macrogol/PEG sachets) draw water into the stool and are commonly used first-line. They soften stools and increase frequency.
• Stimulant laxatives (e.g., senna, bisacodyl) help the bowel move. Often added if stools are soft but difficult to pass, or if macrogol alone is not enough.
• Stool softeners (e.g., docusate) can help if stools are hard/dry.
• Bulk-forming agents (e.g., ispaghula husk) can help if fluid intake is good and there is no impaction.
• Suppositories (e.g., glycerol) may help with hard stool in the rectum; some people need stimulant or bisacodyl suppositories if softeners fail.
• Enemas are sometimes used under clinical guidance for impaction or obstruction concerns.
• Opioid-induced constipation: prevention is best — a regular stimulant plus osmotic is often started when opioids are prescribed; ask your prescriber.

Always read the patient leaflet. Check for interactions (e.g., with warfarin/anticoagulants or electrolyte issues). Report new tummy pain, vomiting, or blood to a clinician.

Faecal impaction — what to do

Impaction is a large, hard stool stuck in the rectum/colon. Clues include persistent constipation with overflow diarrhoea, abdominal discomfort, and a sensation of blockage.

Do not use bulk-forming fibre if impaction is suspected. A typical community plan is:

• High-dose macrogol regimen (as per sachet/GP instructions) to soften and clear.
• Add a stimulant if needed once stools are softer and moving.
• Glycerol or bisacodyl suppository may be advised for rectal loading; sometimes a phosphate enema is required in supervised settings.

Seek clinical advice if you are very uncomfortable, frail, have new severe pain, vomiting, or suspected bowel obstruction.

Special situations (frailty, dementia, Parkinson’s, opioids)

• Frailty/cognitive impairment: keep a simple routine (same time daily), support privacy and dignity, ensure safe hydration, consider a bowel diary and prompts.
• Parkinson’s disease: constipation is common; regular osmotic ± stimulant therapy is often needed; review medicines with your Parkinson’s team.
• After stroke: bowel care plans and toileting support are important; ask your community team for a continence/rehab review.
• Opioids: start preventative laxatives from day one; adjust doses with your prescriber.
• Pelvic floor dysfunction/obstructed defaecation: ask your GP about pelvic health physiotherapy and biofeedback.

When to see your GP & typical checks

See your GP if constipation is new, persistent, or not improving with self-care and pharmacy advice, or if you have any red flags.

Typical GP checks may include: medicine review; physical exam; basic blood tests (e.g., full blood count, thyroid, calcium, glucose); and considering stool tests or bowel investigations based on your symptoms and age.

Prevention & bowel diary

• Keep a bowel diary: date/time, stool consistency (e.g., Bristol Stool Chart numbers), straining, pain, leaks, medicines taken.
• Set gentle movement goals most days.
• Plan meals and drinks you enjoy; small, regular sips help.
• Review toilet access (seat height, footstool, lighting, grab rails).

FAQs

Is long-term laxative use safe?

Many people safely use osmotic or bulk-forming agents long term under clinical guidance. Doses may be adjusted to keep stools soft and comfortable. Report new pain, bleeding, or weight loss.

How much fibre should older adults aim for?

There is no single target for everyone. Build up gradually with a mix of fibre types and adequate fluids. If you are frail or have swallowing issues, ask your GP or a dietitian for tailored advice.

What if I can’t increase fluids?

Prioritise small, regular sips, moist foods (e.g., soups, stews, yoghurt), and speak to your clinician. Bulk-forming supplements may not suit people with fluid restrictions.

What is the best first medicine to try?

Community practice often starts with an osmotic laxative (e.g., macrogol/PEG) then adds a stimulant if needed. A pharmacist can advise based on your medicines and health.