The treatment of constipation in the elderly should be undertaken with considerable care, as they are more sensitive to its possible adverse effects. For most people, including the elderly, a change in diet is always the first step in treating constipation. We should promote diet and lifestyle changes and give them precedence over the use of medications.
Numerous studies have shown that a large intake of dietary fibre can significantly reduce and alleviate the symptoms of constipation. However, it should be emphasised that we should not so much increase the intake of fibre as consume an appropriate amount.
The fact is that fibre is barely present in most diets, especially in the west. We should take care when adding fibre to the diet, since a sudden increase in intake can cause a worsening of symptoms. Ideally, we should increase the intake of both soluble and insoluble fibre, adding wholegrain cereal to the diet along with more fruit and vegetables. Some epidemiological studies have confirmed the beneficial effects of kiwi fruit and prunes on the digestion, while unripe bananas are not recommended. Kiwis and prunes can substantially improve the frequency of bowel movements and stool volume. The stool is softer and enjoying these fruits is very simple. Since unripe bananas are rich in starch that is resistant to amylase (an enzyme that breaks down starch), eating them while constipated can aggravate the symptoms. Some studies have shown that constipation can also be alleviated by consuming fish.
Establishing a healthy intestinal microbiota is essential as well. Although no studies have directly linked the consumption of probiotics with constipation relief, they are nonetheless recommended for the elderly because they promote the growth of bifidobacteria, which become less abundant as we age. Some studies have shown that the composition of the intestinal microbiota changes with age: the beneficial bacteria of the genus Bifidobacterium decline in number, which may indirectly affect the likelihood of constipation.
- Increase fibre intake to the recommended daily amount of 25 to 30 g; however, do this gradually to avert any worsening of the symptoms.
- Recommended fruit: apples, pears, raspberries, and dried fruit (prunes in particular).
- Recommended vegetables: carrots, courgettes, pumpkins, turnips, legumes, celery.
- Recommended cereals: oats, brown rice, wholegrain wheat products, buckwheat, millet.
- Add flax seeds and chia seeds to your diet as well.
- Consume more probiotic yoghurt, kefir, and other foods that are naturally rich in probiotics (pickled cucumbers without vinegar, mozzarela, non-pasteurised sauerkraut, cheddar cheese).
- Avoid unripe bananas, white flour products, fatty and spicy foods, alcoholic drinks, sweet carbonated beverages, sweets, snacks, and smoked products.
- Consume as little of non-fermented dairy products (such as milk) as possible.
- Increase physical activity, if your health allows it, as it is essential for good digestive function, wellbeing, and quality of life. One beneficial activity that is often recommended to the elderly is Nordic walking.
- Drink enough fluids. This is a vital rule, especially if you also aim to increase fibre intake. Only with sufficient hydration can fibre bulk up and do its task. Inadequate fluid intake or dehydration leads to compacted, hard stool. Patients with heart and kidney conditions must control their fluid intake. In such cases, the need for adequate hydration can represent a limiting factor.
We should promote a balanced diet and give it precedence over other medical interventions. If diet and lifestyle changes fail to help, the next step in treatment is the use of osmotic laxatives.
Osmotic laxatives are suitable for patients who do not respond to an increased intake of dietary fibre. When choosing the laxative, we should always consider the patient’s medical history, in particular heart and liver conditions, possible interactions with other medications and/or dietary supplements, and possible adverse effects.
Donat natural mineral water is an excellent choice. Owing to its high sulphate salt content, Donat is a natural osmotic laxative. Drinking 0.3 L of Donat in the morning on an empty stomach and 0.2 L before the evening meal is clinically proven to stimulate digestion. Donat is beneficial to the body, has no adverse effects, and does not cause tolerance.
However, it should be avoided by those suffering from chronic kidney failure, alkalosis, or bradycardia.
In addition to consuming Donat, we should maintain a balanced diet and a healthy lifestyle.