Doris is a healthy 69-year-old woman who recently has had problems with “irregularity,” her polite word for constipation. She thought it was just a symptom of aging, but the problem was really starting to bother her. Despite her embarrassment, Doris summoned up the courage to talk with her primary care provider (PCP), who ruled out any serious concerns. After asking a few questions, the PCP decided to refer her to an RD to evaluate her eating habits. Doris has lots of questions, many of which we will explore here.
What Is Normal?
Normal bowel function varies from person to person. Constipation often is defined generally as infrequent bowel movements or difficult passage of stools that persists for several weeks or longer. A more specific definition is outlined by the Rome IV criteria as the following:
- fewer than three spontaneous bowel movements per week;
- straining for more than 25% of defecation attempts;
- lumpy or hard stools for at least 25% of defecation attempts;
- sensation of anorectal obstruction or blockage for at least 25% of defecation attempts; and
- manual maneuvering required to defecate for at least 25% of defecation attempts.
Is Constipation Related to Aging?
Studies suggest that prevalence of constipation increases with age but that it’s not an inevitable part of the aging process. Aging can cause a slight slowing of the movement of contents through the large intestine and a modest decrease in the contractions of the rectum. But constipation also can be attributed to more frequent use of certain medications, decreased fluid intake, and a decrease in physical activity that often accompanies aging.
Dietary Fiber: How Much and What Type?
For good health, the daily recommended amount of fiber is at least 25 g for women and 38 g for men, but there are nuances to fiber intake that can affect bowel function. Fiber can be described as either soluble or insoluble. Soluble fiber dissolves in water to form a gummy gel. Sources include dried beans, oats, barley, bananas, potatoes, and soft parts of apples and pears. Soluble fiber can slow intestinal transit time and/or solidify loose stools.
Insoluble fiber doesn’t dissolve in water and helps produce softer, bulkier stools that increase fecal transit time. Sources include whole bran, whole grain products, nuts, corn, carrots, grapes, berries, and peels of apples and pears. All fiber is important to overall good health and gastrointestinal function, but insoluble fiber may be more effective than soluble in treating constipation. However, the type of fiber consumed is not the only key to bowel health, because the overall diet as well as other properties of fiber can affect stool viscosity and fermentation in the gut.
Increasing the amount of fiber in the diet gradually will help limit possible side effects such as bloating and gas. When increasing fiber, fluid intake should also increase to as much as 2 L per day. Consuming more than 50 to 60 g of fiber daily may lower the body’s ability to absorb some vitamins and minerals.
A Happy Outcome
Doris’ constipation doesn’t meet the Rome criteria, but it might be treatable with dietary changes. Together, Doris and her RD focus on tweaking Doris’s diet to increase all types of high-fiber foods and adding more fluids. Doris is learning to enjoy whole grain breads and cereals, legumes, and more fruits and vegetables. She’s armed with ideas on how to work more of these foods into her daily meals and snacks. Most of all, she’s relieved that her issue isn’t due to any serious health issue, and it’s not just a symptom of aging. Doris is much happier and feeling better now that she is having more “regularity.”
— Becky Dorner, RDN, LD, FAND, is widely known as one of the nation’s leading experts on nutrition and long term health care. Her company, Becky Dorner & Associates, Inc, is a trusted source of valuable continuing education, nutrition resources, and creative solutions. Visit www.beckydorner.com to sign up for free news and information.