Promoting healthy bowel movements may be a delicate topic, but a vital one to your loved one’s health.

You may be surprised to know how common it is for private conversations among older people to focus upon various approaches to having a good bowel movement.

As people age, they tend to have more and more trouble maintaining healthy bowel movements, according to Jennifer Lunney, an aged care nurse working in a Sydney nursing home.

If you are the carer of an older person, or someone with restricted mobility like cerebral palsy, it is imperative that you keep a close watch on their bowel health. Good health starts in the bowel and chronic constipation over many years can lead to serious and sometimes fatal diseases such as cancer.

If you are working and caring you may have less time to observe your loved one’s toileting habits, but don’t be shy, ask discreetly to establish if there is a problem that needs attention.

Failure to regulate bowel activity is one of the most common complaints of older persons, those with mobility-related disability and people with mental health issues on medication. This problem applies even in individuals who are otherwise quite active, consider themselves well, and suffer from very few illnesses. So, why does it happen? And what can be done about it?

Jennifer said that she often refers people to a good website that can help and recommends www.righthealth.com. Here is a summary of information detailed there.

Medications and illnesses that affect bowel function

A variety of illnesses and medications affect the normal passage of food down the intestine, and the passage of fecal material through the colon to the rectum. The most common is diabetes, but it can also result from conditions in which thyroid hormone activity is low, there is excess calcium, or too little potassium in the blood.

Common diseases of the nervous system that can cause problems in evacuation include Parkinson’s disease, stroke and motor neurone disease. Neurological illnesses such as multiple sclerosis rarely cause changes in the intestines themselves, but they can damage the nerves of the autonomic nervous system (which control heart rate, blood pressure, and breathing) that may alter bowel movement.

Medications are a serious culprit of bowel problems as well. Antihypertensive drugs, calcium channel-blockers, and anticonvulsants may present problems. Iron and calcium supplements, both of which may be very important as supplemental nutrients, and aluminum-containing antacid compounds, including sucralfate, may cause constipation. Also, drugs that are used for the treatment of Parkinson’s disease, antidepressants, and antipsychotic medications are all common causes of bowel roadblocks.

Diagnosing the problem
In order for your doctor to make an accurate diagnosis, the patient will need to tell him or her how frequently they have bowel movements. Help them keep a record for a week to ten days before their appointment, and record the following:

Do they have any stomach or general abdominal pain that either comes and goes or is constant?

Do they have any pain in the rectum?

What does the stool look like?

Are they straining when they defecate?

Do they lose stools either with a little soilage on their underclothes, or is there severe fecal incontinence?

Do they have pain when defecating?

Does passing a stool take a very long time?

Do they have a history of hemorrhoids or any diseases of the rectum?

Is there ever any blood or mucus in their stool?

How frequently do they take laxatives?

Be prepared to give a diet history. All these historical points are important in determining how best to manage any problems your loved one is having and to decide whether they need any tests to eliminate the possibility of serious bowel disease.

Treatment
The first easy treatment for any discomfort is to drink eight glasses of water a day, and add fibre to the diet. High-fibre foods include many fruits and vegetables, bran cereals, and whole-grain bread. Management without drugs should be the foundation of long-term treatment. But when drugs are needed to treat constipation, how should you proceed?

Laxatives
First a warning: habitual laxative use can result in distention of the colon and the rectum and can stop the urge to defecate, which can result in taking even more laxatives. Everyone must be very careful about this problem.

So with this caution, you could start your loved one on an over-the-counter bulk laxative, which contains psyllium and ispaghula. These laxatives can absorb a lot of water, which make it easier to pass stool. However, taking such laxatives makes the colon work harder, and can cause pain, discomfort, or excess gas, so you have to proceed slowly.

Other bulk laxatives include Milk of Magnesia (magnesium hydroxide)) and saline laxatives. Magnesium salts draw fluid into the small bowel and cause movement of feces to the rectum. Products that contain sodium phosphate can also be used to draw fluids into the small bowel. There also are so-called hyperosmolar laxatives that include lactulose, which is a sugar that is not absorbed in the small intestine. Lactulose is broken down by bacteria in the colon and increases the water content, thereby making stool passage easier.

If these types of products don't work, you may need to use stimulant laxatives, which include senna and phenolphthalein-containing compounds such as Ex-Lax or Correctol, or bisacodyl (Dulcolax). These laxatives whip the colon into action, but often result in your loved one needing more and more of the compound to have an effect. It is not a good idea to use senna or Dulcolax for more than seven to ten days.

Suppositories and enemas
Occasionally, if quick action is needed, it is much better to use suppositories, either a glycerine suppository or a Dulcolax suppository, or you could even use an enema. However, overuse of enemas can create problems as well. The colon can get used to the enemas and depend on them for any bowel action at all. Occasionally the lower bowel can be damaged by excessive use of enemas.

Conclusion
These are a few ideas that might help ease any bowel problems your loved one is having. If simple measures don't work, make sure they see their doctor so that you can rule out more serious causes of their discomfort.