The sign of bowel health is ease and comfort—not necessarily having a bowel movement every day.
Bowel movements are part of the daily rhythm of life. But as the decades march on, the rhythm may beat slower and raise concerns. “Some of my patients are absolutely convinced there has to be a daily bowel movement, but actually there is a lot of variation,” says Dr. William Kormos, editor in chief of Harvard Men’s Health Watch and a primary care physician at Harvard-affiliated Massachusetts General Hospital.
As many as half of older adults suffer from constipation, and 10% to 18% use a laxative every day. If bowel movements become less frequent, that may be fine as long as they are without straining or pain. But if you have more than occasional difficulty, consider adding fiber to your diet and ask your doctor or pharmacist if your medications could be contributing.
What is constipation?
The time it takes food to pass through the gut varies considerably from man to man. The period from eating a meal to eliminating the digested remains can be up to several days. But with aging, the body’s waste disposal system can also slow down somewhat. “The main problems are a natural slowdown in the gastrointestinal tract, in addition to a lack of dietary fiber and the effect of medications that are constipating in and of themselves,” Dr. Kormos says.
Having two or more of the following symptoms in the previous three months suggests a diagnosis of constipation:
bowel movements fewer than three times a week
straining or pain during bowel movements
lumpy or hard stools
sensation of incomplete emptying after a bowel movement
sensation of obstruction or blockage
needing to use your fingers to help pass stools or apply pressure to the base of the pelvic area.
Dietary fiber protects against constipation by drawing water, which makes stools bulkier, softer, and easier to pass. If you think you could use more fiber, add it slowly. “Otherwise you may exchange your constipation problem for a gas problem,” Dr. Kormos says. Mix high-fiber cereals into your regular breakfast food, or add a half of a piece of fruit to your meal to start. Always be sure to drink plenty of fluids as well. If you do experience bloating or discomfort, it may ease over time.
When you take in fiber as part of foods, you get healthful nutrients as well as the fiber. But for some people, the harder types of fruits (like apples) and crunchy high-fiber cereals may not be the easiest things to eat. In that case, a fiber supplement might do the trick. These commonly contain psyllium or methylcellulose.
Eating to elimination: how long?
It can take up to several days for food to pass through the gastrointestinal tract and leave the body as a bowel movement.
A number of drugs that older men commonly take can contribute to constipation. These include calcium-channel blockers, narcotic pain medications, antidepressants (particularly mirtazapine), and omeprazole (Prilosec, other brands). You can ask your pharmacist about possible constipating effects, but don’t go off a drug or change your dose without consulting your doctor.
See a doctor if you experience these symptoms:
Laxatives: Try osmotics first
Osmotic laxatives draw water into the bowels and make stool softer and easier to pass. “Those are safe because they do it naturally, and don’t put any stress on bowel function,” Dr. Kormos says. The active ingredients in common osmotic laxatives include polyethylene glycol, sorbitol, and lactulose.
Other common over-the-counter options include saline laxatives (magnesium hydroxide, magnesium citrate) and bowel stimulants, such as senna, bisacodyl, cascara, and castor oil.
Use stimulant laxatives only occasionally—when you really need to get things moving—and take the minimum dose required. “If you overdo stimulant laxatives, the bowels get progressively more ‘lazy’ and harder to move,” Dr. Kormos says.