Constipation After 60: Why It Happens and What It Means for Health

In this episode, Dr. Kernisan highlights how common constipation is—across all ages but especially in older adults—and pushes back against the idea that it’s just a “punchline.” She emphasizes its real impact on quality of life and health in geriatrics. Chronic constipation affects roughly 10% of people worldwide, drives significant discomfort and healthcare costs, and often leaves patients frustrated with dietary, medication, and behavioral treatments.

Constipation After 60: Causes, Relief & Safe Treatments (YouTube link)

Symptoms

Chronic constipation is typically identified using the Rome IV criteria, which require at least two of the following for three months:

• Hard or lumpy stools
• Straining during bowel movements
• A sense of incomplete evacuation
• Needing manual maneuvers to pass stool
• A feeling of blockage in the rectum
• Fewer than three bowel movements per week

People may also experience no urge to defecate, repeated unsuccessful toilet trips, bloating, or discomfort. These symptoms can significantly reduce quality of life and contribute to healthcare costs. Although frequency varies with age, one bowel movement per day is generally considered ideal.

Multifactorial Constipation in the Elderly

Constipation in older adults often stems from multiple overlapping factors and is frequently described as a geriatric syndrome—a multifactorial condition tied to aging-related vulnerabilities like frailty, polypharmacy (use of multiple medications), reduced mobility, multimorbidity, and physiological changes (e.g., slower colonic transit, rectal hyposensitivity, or weakened pelvic floor muscles). It is rarely due to a single cause and is typically multifactorial rather than a normal part of aging.

Causes are commonly classified into two broad categories:

• Primary (Functional) Causes
• Secondary Causes

Primary (Functional) Causes

These are intrinsic to the bowel or defecation process itself, without an identifiable underlying disease or external trigger. They include subtypes like:

• Normal transit constipation — Hard stools or straining with normal frequency, often linked to diet or habits.
• Slow transit constipation — Delayed movement of stool through the colon due to reduced motility (common in aging from age-related nerve/muscle changes).
• Outlet/defecatory dysfunction — Difficulty expelling stool (e.g., pelvic floor incoordination or rectal issues).

In older adults, primary causes are often intertwined with lifestyle factors that exacerbate functional issues.

Lifestyle-Related (Often Primary or Contributing):

• Low dietary fiber intake (reduces stool bulk and promotes slower transit).
• Inadequate hydration/dehydration (makes stools harder; common due to reduced thirst sensation, fluid restrictions for heart/kidney issues, or fear of incontinence).
• Reduced physical activity/immobility (weakens abdominal/pelvic muscles, slows gut motility; linked to frailty and sedentary behavior).
• Magnesium deficiency — impairs muscle and intestinal function, slowing colonic movement; low intake is linked to a higher risk of chronic constipation in population studies.

Secondary Causes

These result from identifiable external or systemic factors, such as medications, diseases, or structural issues. Secondary constipation is especially prevalent in older adults due to higher rates of chronic illnesses and polypharmacy.

Medications (a major driver via polypharmacy):

• Opioids (painkillers like codeine, morphine, oxycodone) — strongly slow gut motility.
• Anticholinergics (e.g., certain antihistamines, overactive bladder drugs, tricyclic antidepressants, antipsychotics).
• Calcium channel blockers (for blood pressure/heart conditions).
• Iron supplements (common forms like ferrous sulfate).
• Antidepressants (especially tricyclics or others with anticholinergic effects).
• Diuretics, antacids (aluminum- or calcium-based), beta blockers, and others.

Underlying Medical Conditions:

• Endocrine/metabolic: Hypothyroidism (slows metabolism and gut function); diabetes (neuropathy affecting nerves); hypercalcemia or electrolyte imbalances.
• Neurological: Parkinson's disease (constipation often precedes motor symptoms by years due to autonomic dysfunction); multiple sclerosis; other neuropathies or autonomic issues.
• Gastrointestinal/structural: Colorectal cancer or obstruction (red flags: blood in stool, pencil-thin stools, unexplained weight loss, persistent bloating, abdominal pain, nausea); diverticulosis; IBS (constipation-predominant); pelvic floor disorders.
• Other systemic: Chronic back pain (muscle spasms disrupt nerve signals); frailty-related muscle weakness; depression/anxiety (psychosocial factors reducing activity or ignoring urges).

Constipation is considered a geriatric syndrome because it rarely has a single cause. Managing it usually means addressing multiple contributors at once—beginning with reversible factors like medications and lifestyle before moving to more advanced evaluation.

Health Consequences

Chronic constipation in older adults is far more than a simple nuisance—it is a significant trigger for physical, psychological, and functional decline. The immediate consequences often manifest as abdominal discomfort, bloating, and reduced appetite, which can spiral into painful complications like hemorrhoids or fecal impaction. In more vulnerable patients, these physical burdens translate into behavioral shifts, such as irritability in those with dementia or even sudden delirium. This distress often leads to a dangerous avoidance of necessary medications due to the fear of pain, creating a cycle of worsening health.

Because these symptoms ripple outward, chronic constipation is increasingly recognized as a multifactorial geriatric syndrome deeply linked to frailty, immobility, and polypharmacy. When left unmanaged, the condition does more than reduce quality of life; it raises healthcare costs and elevates the risk of severe outcomes like infections, falls, and increased mortality. It is a misconception to view this decline as a "normal" part of aging. Instead, early evaluation through lifestyle changes and safe clinical interventions can prevent the majority of these complications. However, it is vital to remain vigilant for "red flags"—such as blood in the stool or unexplained weight loss—which require immediate medical attention to rule out more serious underlying issues.

References

1. Dimidi E. Dietary management of chronic constipation: a review of evidence-based strategies and clinical guidelines. Proc Nutr Soc. 2025 Dec;84(4):398-410.
• Comprehensive review of dietary remedies like fiber, psyllium, probiotics, prunes, kiwifruit, rye bread, and magnesium; aligns with clinical guidelines.
2. AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review. Clin Gastroenterol Hepatol. 2026 Jan 7.
• Expert guidance on refractory cases, including stepwise remedies: exclude causes, trials of OTC laxatives, combinations, and advanced options like surgery
3. Nonpharmacologic treatment for elderly with constipation: a systematic review and meta-analysis. Front Med (Lausanne). 2025 Sep 12;12:1644609.
• Strong evidence for non-drug remedies in older adults: acupuncture, abdominal massage, ear acupoints, probiotics, dietary fiber; lower adverse events and better outcomes vs. controls.
4. Fructooligosaccharides for Relieving Functional Constipation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Foods. 2024 Dec 11;13(24):3993.
• Prebiotic FOS as a dietary remedy: increases bowel frequency, softens stool, reduces straining/pain; mild bloating noted.
5. Clinical efficacy of non-pharmacological treatment of functional constipation: a systematic review and network meta-analysis. Front Cell Infect Microbiol. 2025.
• Ranks non-pharmacological remedies: FMT top for stool form/frequency, acupuncture for overall efficacy, probiotics safest.
6. Effects of Manual Therapy on Patients with Functional Constipation: Systematic Review and Meta-analysis of Randomized Clinical Trials. J Manipulative Physiol Ther. 2025 Jul-Dec;48(6-9):712-723.
• Manual therapy improves severity, quality of life, frequency, and duration of defecation.
7. The Efficacy of Lubiprostone in Patients of Constipation: An Updated Systematic Review and Meta-Analysis. (Journal details 2025/2026).
• Pharmacological remedy: lubiprostone effective for spontaneous bowel movements in CIC, IBS-C, OIC.
8. Comparative Efficacy and Safety of Lubiprostone and Osmotic Laxatives in Chronic Idiopathic Constipation: A Systematic Review and Network Meta-Analysis.
• Compares lubiprostone favorably to PEG/lactulose for increasing bowel movements.