Chronic constipation management and prevention

Chronic constipation affects a significant portion of people over the age of 65. It is defined not just by frequency, but by hard stools, excessive straining, the sensation of incomplete evacuation, or the need for specific maneuvers to defecate.

Common causes include reduced physical activity, lower intake of water and fiber, changes in pelvic musculature, and various medications such as opioids, certain antidepressants, aluminum-based antacids, iron or calcium supplements, and some antihypertensives. Reviewing current medication is often an effective first intervention.

Recommended lifestyle adjustments include a gradual increase in fiber intake through vegetables, fruits with skin, legumes, oats, dark bread, and dried prunes, alongside adequate hydration. Daily physical activity and establishing a consistent routine can also assist.

Regarding medical aids, bulk-forming laxatives are considered closest to natural processes but require hydration. Osmotics, such as macrogol and lactulose, are commonly used for chronic cases and are safe for long-term use under guidance. Stimulant laxatives, including senna teas, act quickly but carry risks of habituation and potassium loss if used continuously. Suppositories and enemas should be reserved for occasional use.