Dementia describes a decline in cognitive functions, such as memory, thinking, and reasoning, which impacts daily life. Constipation refers to infrequent or difficult bowel movements, often characterized by hard stools or straining. While seemingly unrelated, constipation is a common co-occurring issue in individuals living with dementia, presenting a challenge for both patients and caregivers. Understanding this connection can help improve the well-being of those affected.
Why Constipation Occurs
The aging process itself contributes to slower digestion, and neurological changes associated with dementia can further affect gut motility. Neurological changes in dementia can affect autonomic nervous system functions that control bowel movements. This neurological disruption can slow the transit time of food through the digestive tract.
Many medications often prescribed for dementia symptoms or co-existing conditions can cause constipation as a side effect. Anticholinergic drugs, often used to manage bladder issues or certain behavioral symptoms, can slow gut muscle contractions. Pain medications, antidepressants, and even some over-the-counter remedies can also contribute to reduced bowel activity.
Dietary and lifestyle factors play a major role in constipation for individuals with dementia. Reduced fluid intake, often due to decreased thirst sensation or difficulty accessing drinks, can lead to harder stools. A diet low in fiber, which is common if individuals consume fewer fruits, vegetables, and whole grains, exacerbates this. Decreased physical activity, common as dementia progresses, also slows bowel function.
Cognitive and behavioral changes associated with dementia can further complicate bowel regularity. Individuals may have difficulty communicating their need to use the toilet or recognizing the sensation of a full bowel. Forgetting to go to the toilet or resistance to toileting assistance, due to confusion or fear, can lead to prolonged stool retention, increasing constipation risk. Changes in routine or environment can also disrupt normal bowel habits.
How Constipation Affects Dementia
Physical discomfort from constipation causes abdominal pain, bloating, and a reduced appetite. Individuals may experience nausea or malaise, which can further impact their nutritional intake. This persistent discomfort can lead to a decline in overall quality of life.
The discomfort caused by constipation often translates into behavioral changes, which can be mistakenly attributed to worsening dementia. Increased agitation, restlessness, and even aggression can stem from an inability to articulate the pain or pressure. Wandering behavior or withdrawal from social interaction might also be an attempt to cope with physical distress.
Constipation can also impact cognitive function, potentially leading to increased confusion or delirium, an acute state of mental confusion. The discomfort and physiological stress can contribute to a decline in alertness and cognitive performance. Dehydration, often associated with constipation, exacerbates cognitive impairment and can precipitate delirium.
Unresolved constipation can lead to serious health complications. Fecal impaction, a mass of hardened stool lodged in the colon or rectum, is a painful and dangerous condition. Chronic constipation also increases the risk of urinary tract infections (UTIs) and hemorrhoids, adding to distress and requiring medical intervention.
Approaches to Management
Dietary adjustments are a key approach to managing constipation, focusing on increasing fiber and fluid intake. Incorporating more fruits, vegetables, and whole grains, such as oats and brown rice, can add bulk to stool, making it easier to pass. Aiming for a daily fiber intake of 25-30 grams, if medically appropriate, can improve bowel regularity.
Adequate fluid intake is equally important, as water softens the stool and aids its passage. Encouraging the consumption of 6-8 glasses (approximately 1.5-2 liters) of water, diluted juices, or other non-caffeinated beverages throughout the day can prevent dehydration. Offering fluids frequently and at regular intervals can help meet these hydration goals.
Promoting physical activity, even gentle forms, can stimulate bowel movements. Regular walks, chair exercises, or even simple stretching can aid gut motility. Any increase in movement, tailored to the individual’s ability and safety, can contribute positively to digestive health.
Establishing a consistent toileting routine can help train the bowels. Encouraging the individual to attempt a bowel movement at the same time each day, often after a meal when the gastrocolic reflex is most active, can be beneficial. Responding promptly to any cues or expressions of needing to use the toilet is also important.
A medication review by a healthcare professional is an important step in managing constipation. Some medications may be contributing to the problem, and alternative options or dosage adjustments might be considered. Never discontinue or alter medications without consulting a doctor.
While lifestyle changes are preferred, medical interventions, such as laxatives or stool softeners, may be necessary under professional guidance. Bulk-forming laxatives, osmotic laxatives, or stool softeners can help, but their use should be carefully managed to avoid dependency or side effects. These are considered after dietary and lifestyle modifications have been attempted.
Monitoring bowel movements and communicating any changes or concerns to healthcare providers is important. Keeping a simple log of bowel movement frequency, consistency, and any associated discomfort can provide useful information. This ongoing communication ensures that management strategies remain effective and are adjusted as needed.