Good bowel health is important for people of all ages. Emptying your bowels regularly and with ease is an important part of good bowel health. Some people may experience bowel problems as they get older and it is common for constipation to affect two out of three residents in Aged Care homes. Constipation is usually characterised by hard, dry stools that are painful to pass. A person may also feel bloated and experience abdominal cramps. Constipation can result in a decrease in appetite and intake which can then lead to malnutrition.

There are many reasons that a person may experience constipation such as:

• Changes in every day routines
• Inadequate water or fibre in the diet
• Lack of exercise
• Medications especially those used to manage pain
• Ageing
• Cancer

To help prevent constipation, the following key factors should be considered:

1: Increase Fibre in the diet

Residents in Aged Care homes often have a diet low in fibre. This may be related to any one of the following: –

• their preference for low fibre options for taste reasons
• residents may avoid fibrous fruit and vegetables due to poor oral health or lack of dentition.
• the menu may have insufficient foods that are good sources of fibre
• residents with poor appetite/intake and those missing meals may not get sufficient fibre.
• residents on texture modified diets such as pureed diets, will have decreased fibre intake due to less bread/cereals/fruits

It is important to aim for 25-30g fibre per day from foods such as weetbix, All bran, wholemeal/grain bread and crackers, baked beans, prunes, barley soup, fruit, vegetables, nuts, seeds, legumes

2: Increase Fluids in the diet

On average, 6-8 glasses of fluids (preferably water) per day is required to assist with the prevention of constipation and also dehydration. As we age, the sensation of thirst can be reduced, and so the elderly can show signs of dehydration before they even feel thirsty. To increase fluids for those residents who struggle to consume 6-8 glasses of fluids per day, the following suggestions may assist:

• offer small drinks often
• provide a variety of drinks
• fill glasses regularly during meals, regular hydration rounds
• leave drinks within easy reach
• Assist residents with regular hydration if they are unable to help themselves
• Include foods containing fluids e.g jelly, custard, soups regularly during the day

3: Include daily exercise as tolerated

As the saying goes “any amount of exercise is better than none”. The abdominal muscles support gut motility and any form of exercise will assist with this.

Exercise will also help to stimulate hunger and increase appetite.

IN SUMMARY
It is important for staff to have a good knowledge of high fibre foods and to encourage residents to select them when choosing meals from the menu to ensure the recommended 25-30 grams of fibre is consumed daily.

Staff should encourage fluids at every opportunity and also take into consideration that some medications can cause constipation – hence the need to be extra vigilant with offering fluids.
Encourage regular exercise as tolerated and approved by the GP.