Diet Plan for Constipation in the Elderly

Constipation can be a painful and uncomfortable condition that affects people of all ages. Nearly 16 in 100 adults in the United States experience constipation. Older adults tend to determine constipation based on symptoms like pain, stool hardness or straining rather than frequency alone. Chronic constipation is common in adults older than 60 years, and symptoms occur in up to 50% of nursing home residents. There is a link between ageing and the likelihood of constipation for those who are 70 years or older. Fortunately, dietary modifications can often provide relief. This article explores a diet plan for constipation in the elderly, including foods to include and those to limit, and when to consult a doctor.

Understanding Constipation

Typically, a person should have three or more bowel movements per week. If a person has fewer, they may be experiencing constipation. People with constipation may pass stool that is dry, hard, or lumpy, and their stool may be painful or difficult to pass. A person may also experience a feeling of not having passed all the stool in their system. The term constipation refers to difficulty during defecation and infrequent bowel movements over an extended period of time. Symptoms include hard/dry stool, bloating and abdominal pain. Definitions of normal bowel function vary, but frequency can range between three times per week to three times per day.

Risk Factors for Constipation

Lifestyle issues can contribute to constipation particularly the following:

• Low-fiber diet: Fiber is the indigestible part of plant-based foods. As fibre is indigestible, it adds bulk to the faeces, making it more easily pushed along the digestive tract. There are two broad types of fibre; soluble and insoluble. Soluble fiber dissolves in water and helps to slow digestion and helps to soften the faeces. Good sources of soluble fibre include legumes, fruits and vegetables. Insoluble fiber does not dissolve in water and helps support regular bowel movements and adds bulk to the faeces, helping it to move more quickly through the bowel. Good sources of insoluble fibre are in wheat bran, wholegrain breads and cereals. A lack of fibre can increase the risk of constipation.
• Insufficient fluids: The fibre in faeces will only plump and soften up with water. Constipation can occur from a high-fibre diet if insufficient water is consumed.
• Lack of regular exercise: Living a sedentary lifestyle or being restricted in movement due to a disability or physical impairment are common causes of constipation. One of the many benefits of regular exercise is improved bowel motility. Ideally, exercise should be taken every day for about 30 minutes. People with a condition that affects mobility need to be as active as possible each day, as every little bit of regular exercise helps. Consult with your facility physiotherapist for strategies to help individuals increase activity. Being physically active may relieve constipation by stimulating contractions in your intestines, encouraging the urge to pass a bowel movement. Regular exercise also benefits your overall well-being and has physical and mental health benefits.
• Ignoring the urge to go: A tendency to ‘put off’ going to the toilet - ignoring the urge to go means that more water will be extracted from the stools, making them difficult to pass. Regularly ignoring this urge may make the body less sensitive to normal signals to go to the toilet. Adults can try bowel training by going to the bathroom at the same time every day. Developing this habit could teach your digestive system how to stay regular. To start bowel training, listen and act when your body needs to go to the bathroom. Don’t postpone pooping, and give yourself plenty of time to pass a bowel movement.
• Certain medications: Some medications - such as narcotics (particularly codeine), antidepressants, iron supplements, calcium-channel blockers (antihypertensives, particularly verapamil) and non-magnesium antacids are known to slow bowel movements. Prescription medications can cause constipation and other side effects to your digestive system. If you’re taking any drugs, ask your doctor if they could be contributing to less frequent bowel movements. They may be able to offer alternative drugs or recommend other treatment options to help you go more often.
• Illness: A period of illness, particularly an illness resulting in hospitalisation and bed-rest, typically results in constipation. Factors include change in routine, reduced food intake, pain (especially after abdominal surgery), and pain-relief medication such as morphine.
• Underlying medical problems: Underlying medical problems can cause constipation such as: ‘Slow transit’, Anal fissure, Obstruction, Hernia, Abdominal or gynaecological surgery, Irritable bowel syndrome, Problems of the endocrine system, Tumour, Diseases of the central nervous system

Dietary Recommendations for Constipation Relief

Doctors recommend that people with constipation increase their fluid and fiber intake to improve bowel movement. A diet plan for constipation may include fruits, vegetables, whole grains, plenty of water, and other fluids. Eating a balanced diet may also help to manage constipation. A 2022 study that examined the association between dietary factors and constipation in adults found that better adherence to the healthy eating index-2015 (HEI-2015) may improve constipation symptoms and facilitate bowel movement. The HEI-2015 is a measure for evaluating overall dietary quality, and researchers score it based on the DGA.

Increasing Fiber Intake

Dietary fiber is the indigestible part of plant-based foods. Fiber helps soften the stool so it passes through the colon smoothly. A person needs a healthy portion of soluble and insoluble fibers to help prevent constipation. The DGA recommends that adults consume about 22-34 grams of fiber a day, depending on their age and sex. A general recommendation for those over 70 years is 25-30g of fibre every day. A 2020 study indicates that consuming food rich in dietary fiber may help with improving gut motility, maintaining gut microbiota health, and preventing the risk of colorectal cancer. Gut motility refers to the movement of food along the digestive system.

Read also: The Hoxsey Diet

Sources of Soluble Fiber:

• Brussels sprouts
• Avocados
• Apples
• Oats
• Lima beans
• Bananas
• Black beans
• Peas

Examples of Insoluble Fiber Sources:

• The skins of many fruits and vegetables
• Whole wheat flour
• Seeds
• Bran
• Nuts

Increasing Fluid Intake

Research from 2017 found that low fluid intake is associated with constipation. Additionally, experts suggest that dehydration and low fluid intake may negatively affect bowel movement and lead to constipation. The NIDDK recommends drinking plenty of water and other fluids, including clear soups and fresh juice. Encourage residents to drink regularly, not only at meals but in between meals. Staff should offer fluids whenever they enter a resident’s room. For residents at risk of a low fluid intake, monitor consumption using a fluid balance chart. The organization notes that drinking a sufficient amount of fluids may have the following benefits:

• Making stool softer
• Preventing dehydration
• Making stool easier to pass
• Preventing constipation

Foods to Include in Your Diet

Eating foods high in fiber, like certain fruits and vegetables, may help relieve constipation. These foods may soften, accelerate, and increase your stool frequency. Here are some foods that could help relieve constipation:

Fruits: Many fruits naturally contain fiber, but some contain more than others. They may also contain other ingredients that can help support frequent bowel movements.

• Prunes (dried plums): One 1/4 cup (40 gram (g)) serving contains nearly 3 g of fiber, which helps add bulk to stool. The soluble and insoluble fibers in prunes also help retain water and produce fatty acids that increase stool weight. Some people may experience a laxative effect from the sugar alcohol sorbitol found in prunes.
• Apples: One medium apple with the skin on (about 200 g) contains 4.8 g of fiber. They also contain pectin, which may have many benefits, such as increasing stool frequency, decreasing stool hardness and duration, and decreasing the need for laxatives.
• Pears: One medium-sized pear (178 g) contains 5.5 g of fiber. Pears contain sorbitol and fructose, which may act as a mild laxative. The liver absorbs fructose, so any excess may draw water into your intestines and aid in bowel movements. However, more research is needed to confirm these effects.
• Kiwis: One kiwi (75 g) contains about 2.3 g of fiber. Kiwis may help relieve constipation by improving stool consistency, decreasing stool duration, and decreasing abdominal pain, strain, and discomfort. This may also be due to the enzyme actinidin, which might have positive effects on gut motility and bowel habits.
• Figs: One 1/2 cup (50 g) serving of dried figs contains 7.3 g of fiber. Research suggests consuming figs regularly may not only help with stool frequency but may help alleviate abdominal discomfort such as pain or bloating.
• Citrus fruits: One orange (154 g) contains 3.7 g of fiber, while one grapefruit (308 g) contains nearly 5 g. Citrus fruit peels are rich in pectin and a flavanol called naringenin, which may help reduce constipation. Studies with mice suggest this may have laxative effects, though more research with humans is necessary.

Vegetables: Like with fruit, some vegetables are more fibrous than others. The following options are known for having a bit more, and eating them can help reduce constipation.

• Spinach and other greens: Greens like spinach, Brussels sprouts, and broccoli are full of fiber, which might help add bulk and weight to stools, making it easier to pass. 100 g of cooked spinach has 1.6 g fiber. Just 5 Brussels sprouts contain 3.5 g of fiber, while broccoli has 2.4 g of fiber in just one cup (91 g).
• Jerusalem artichoke and chicory: Jerusalem artichokes and chicory are part of the sunflower family and contain inulin, a fiber that promotes gut health. A study with 44 adults showed that taking 0.4 oz or 12 g of chicory-derived inulin per day can improve stool frequency and softness.
• Artichoke: One medium raw artichoke (128 g) also contains 6.9 g of fiber. These have a prebiotic effect, which may help increase stool frequency. Prebiotics are indigestible carbohydrates that feed the beneficial bacteria in your gut, known as probiotics.
• Rhubarb: One cup (122 g) of rhubarb contains 2.2 g of dietary fiber. The plant contains sennoside A, a compound that decreases aquaporin 3 (AQP3), a protein regulating the movement of water in the intestines. Less AQP3 means less water is moved from the colon back into the bloodstream, leaving stools softer and promoting bowel movements.
• Sweet potatoes: One medium sweet potato (150 g) contains 3.6 g of fiber. This root vegetable mostly contains insoluble fiber in the form of cellulose and lignin. But, they also contain pectin, a soluble fiber, suggesting it may have a positive effect on bowel movements.

Seeds and Legumes: Seeds and legumes are other great sources of fiber.

Read also: Walnut Keto Guide

• Beans, peas, and lentils: One cup (182 g) of cooked navy beans contains a whopping 19.1 g of fiber, while one 1/2 cup (99 g) of cooked lentils contains 7.8 g. With their mix of both insoluble and soluble fiber, they may help alleviate constipation by adding bulk and weight to stools and by softening them to facilitate passage.
• Chia seeds: These seeds are one of the most fiber-dense foods available, containing nearly 28% of fiber by weight. Just 1 ounce (28 g) contains 9.8 g of fiber. The insoluble fiber in chia forms a gel in the gut when mixed with water, helping to soften and pass stools. Chia can also absorb up to 12 times its weight in water, which helps add bulk to stools.
• Flaxseeds: One tablespoon (9 g) of whole flaxseeds contains 2.5 g of soluble and insoluble fiber. In one study, 53 people with type 2 diabetes ate either flaxseed or placebo cookies. After 12 weeks, the flaxseed group had reduced constipation and improved blood sugar and fat levels. However, speak to your doctor before trying flaxseed if you’re pregnant or lactating.

Grains: Grains also contain a lot of fiber. That said, stay away from processed grains like white bread.

• Rye bread: Two medium slices (64 g) of whole-grain rye bread contain 3.7 g of dietary fiber. Rye bread may help relieve constipation due to its high soluble fiber content, which absorbs water and promotes the formation of larger and softer stools, making them easier to pass.
• Oat bran: This is the fiber-rich outer casing of the oat grain. One 1/3 cup (31 g) of raw oat bran contains 4.8 g of fiber, compared with 2.7 g in quick oats. Although more research is needed, there is some evidence to suggest that eating oat bran can have a positive effect on bowel movements.

Fermented Dairy: Most dairy won’t necessarily help constipation, but it can help if it’s fermented.

• Kefir: This fermented milk beverage is a probiotic, which means it contains bacteria and yeasts that benefit your health when ingested. For example, one study in 45 people with inflammatory bowel disease (IBD) found that drinking 13.5 oz (400 milliliters (mL)) of kefir twice daily improved the composition of the gut microbiome and decreased abdominal pain.

Foods to Limit

According to the National Institute on Aging, consuming certain foods may increase a person’s risk of constipation. Conversely, a person may consider limiting foods that may trigger constipation, such as high fat and processed foods. If you’re experiencing constipation, certain foods and beverages may make your symptoms worse. A person may decide to limit these foods in their diet to help lower their risk of constipation:

• High fat meats, including pork, beef, and lamb
• Dairy products, including high fat milk, butter, and cream
• Processed foods, including: some frozen meals, snacks, pastries, some microwaveable meals, sweets, eggs, chips, fast food
• Alcohol
• Foods with gluten
• Unfermented dairy products
• Red meat
• Foods that are high in saturated and trans fats

Additional Tips for Managing Constipation

• Consider Fiber Supplements: Fibre supplements - these may be helpful if the person is reluctant or unable to include more wholegrain foods, fresh fruits or vegetables. As fibre supplements can aggravate or cause constipation, always check with the doctor or dietitian when using them.
• Review Medications: Ask your healthcare provider if any medications could be contributing to less frequent bowel movements.
• Try Over-the-Counter Products: Stool softeners and laxatives can make it easier to go to the bathroom. You don’t need a prescription to use these products, but you should ask your healthcare provider if they’re appropriate for you. A pharmacist can teach you how to use them safely and effectively.
• Regular Toileting and Education: Regular toileting and education.
• Address Underlying Disorders: Treatment for underlying disorder.

Sample Meal Plan for Constipation

Here’s a seven-day meal plan to try the next time you’re constipated. Also, remember to drink water and other hydrating fluids (unsweetened tea, etc.) throughout the day to help your digestive system adapt. Ask your dietitian for specific serving size recommendations.

Day 1

• Breakfast: Boiled millet (use milk, water, or an unsweetened plant-based alternative) with mixed berries, mixed roasted nuts, and ground cinnamon.
• Lunch: Use a whole-grain wrap to make a roasted chicken wrap with feta cheese and homemade slaw. Make your slaw by grating red cabbage, nappa cabbage, sweet onion, and carrot. Dress with olive oil, white vinegar, salt, ground pepper, and a pinch of cayenne pepper.
• Dinner: Stir-fry with broccoli, green beans, cauliflower, carrot, garlic, ginger, onions, and edamame beans. Season with sesame oil and seeds, green onion, and soy sauce. Serve with brown rice.
• Snacks: Air-pop popcorn dusted with nutritional yeast and chili powder; apple slices with almond butter (garnished with ground flax seed).

Day 2

• Breakfast: Black bean skillet with salsa, avocado, and fresh red onion. Serve with a hard-boiled egg and a slice of toasted whole-grain bread.
• Lunch: Make burritos with whole-grain tortillas, brown rice, grilled shrimp, leftover slaw (from day 1 lunch), and shredded cheddar cheese. Dress with tahini and olive oil.
• Dinner: Grilled steak served with roasted eggplant and acorn squash. On the side, add a salad (shredded kale, cucumber, green onion, sliced almonds, and green peppers) dressed with olive oil and balsamic vinegar.
• Snacks: Plain Greek yogurt with bran flakes, mixed berries, and a few dark chocolate chips; Carrot and celery sticks with hummus.

Day 3

• Breakfast: Blend fiber-rich berries, plain Greek yogurt, chia seeds, hemp hearts, and instant oats to make a high-fiber smoothie bowl. For flavor, add almond butter and a teaspoon of cocoa.
• Lunch: Quinoa bowl with leftover steak, shredded kale, red onion, and diced apple. Add toasted almonds and dress with a simple olive oil and balsamic vinaigrette.
• Dinner: BBQ pork tenderloin (or bake) with a side of grilled asparagus and grainy wheatberry salad (add cucumber, tomato, feta, red onion, olives, and lemon vinaigrette).
• Snacks: Whole-grain crackers with tuna and avocado; Banana with peanut butter (garnished with ground flax seed).

Day 4

• Breakfast: French toast with whole-wheat bread. Decorate with ground flax, mixed nuts, mixed berries, and fresh diced pears.
• Lunch: Roasted ham sandwich with whole-grain bread, hummus spread, romaine lettuce, sprouts, tomatoes, and avocado. Serve with a yogurt cup on the side-top with berries and nuts.
• Dinner: Baked tofu seasoned with Chinese five-spice and ground ginger. Serve over brown rice, adding fresh orange slices, spinach leaves, cilantro, roasted cashews, sesame oil, and edamame beans. Sprinkle sesame seeds on top before eating.
• Snacks: High-fiber Kind nut bar; Raw broccoli and cauliflower with hummus.

Day 5

• Breakfast: Boiled oatmeal with mixed nuts, peaches, walnuts, unsweetened coconut, and ground cinnamon. You can make your oatmeal with milk, plant-based alternatives, or water.
• Lunch: Vegetable bean soup with kidney beans, diced tomatoes, cauliflower, sweet potato (skin-on), onion, garlic, and red pepper. Add low-sodium vegetable stock, almond butter, and harissa spice blend (popular in African cuisine) for flavor, and garnish with fresh cilantro before eating.
• Dinner: Baked salmon filet served with wild rice, sautéed Brussels sprouts with sliced almonds, and fresh tomato and cucumber salad.
• Snacks: Greek yogurt with bran flakes and mixed berries; Whole-grain crackers with cheddar cheese and sliced cucumber.

Day 6

• Breakfast: Whole-wheat muffins made by combining and baking shredded carrot, mixed nuts, ground flax seed, olive oil, egg, and Greek yogurt. For flavor, add ground nutmeg and ginger.
• Lunch: Curried tofu and lentils (stew canned brown lentils, onions, garlic, fresh tomatoes, and spices) served with brown rice and a fresh side salad.
• Dinner: Turkey meatballs served with lentil pasta. Add red tomato sauce, red peppers, onions, garlic, and fresh basil.
• Snacks: Frozen Greek yogurt bark with berries and sunflower seeds (to make, spread Greek yogurt on a lined baking sheet and sprinkle toppings-freeze for two hours before cracking and eating); Roasted edamame beans topped with grated garlic and ginger.

Day 7

• Breakfast: Chia seed pudding with milk (animal or plant-based), diced mango, unsweetened coconut shavings, a small handful of chocolate chips, and mixed nuts (this recipe should be made the night before).
• Lunch: Shredded kale salad with white beans, roasted pecans, blueberries, red onions, and crumbled goat cheese. Dress with a white wine vinaigrette.
• Dinner: Make a bean quesadilla by first warming and mashing pinto beans in a pan. Then, spread the beans on a whole-grain tortilla, add diced onions and tomato, and sprinkle with shredded cheese. Warm in a pan and serve with guacamole, sour cream, and salsa.
• Snacks: Air-popped popcorn dressed with nutritional yeast and paprika; Roasted chickpeas.

When to See a Doctor

If a person has symptoms of constipation that do not go away, they should speak with their doctor. Frequent constipation could be a symptom of other digestive health conditions, like irritable bowel syndrome (IBS). Complications of chronic constipation can be serious such as impaction, incontinence, prolapse or haemorrhoids. It is therefore important to reduce lifestyle risks as possible.

Read also: Weight Loss with Low-FODMAP

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