Constipation, Pt. 1: Causes

Constipation is a big issue with dementia, especially LBD, where a compromised autonomic nervous system can slow down the whole digestion process. In fact, it is often one of the first symptoms that care partners remember, looking back. Of course, they didn’t connect it with LBD at that time. This was the case with Jim’s first wife, Annie. She had chronic constipation for years before she had any cognitive evidence of dementia. In fact, it was so bad that she chose to have an elective surgical procedure to improve it.

If she and Jim had known what he knows now, they would never have Bene that. But back in the late 1990’s very little was known about LBD and neither they nor any of their doctors thought to connect constipation with dementia. Nor did they consider the risk of surgery for someone who was already exhibiting more than one symptom that we know now warns of LBD: her constipation and active dreams—and age, which is the most common risk factor of all. It was after that surgery that she started having hallucinations and Jim took over the cooking after one too many “burnt offerings.” Once a skilled cook, Annie was no longer safe around a stove.

In Annie’s case, dementia wasn’t even considered as the cause of her constipation. But issues with identifying a cause can be the reverse too. Once dementia is known to be present, it is all too easy to blame it for any problem that comes up, including constipation—and often you’d be right. However, as a substance-abuse nurse, I learned that “an alcoholic has the right to any disease known to man.” This applies to dementia too. There are many other causes of constipation besides dementia. Crohn’s disease, for example.

Fast forward twenty years, and Jim is now the one experiencing bouts of constipation. Although he doesn’t have dementia, he is well past 60 and age is the biggest risk factor for constipation. However, in his case, we think first of Crohn’s disease. He hasn’t had a bout of Crohn’s for a couple of years, but we still worry. This disease, sometimes called ‘arthritis of the intestine” inflames the bowel lining and shrinks its working space, making constipation a constant threat. We know that even if it isn’t involved yet, it might be if we don’t get the constipation under control.

There are many other conditions besides age and Crohn’s that increase constipation risks. I’ve already mentioned LBD. It and other Lewy body diseases like Parkinson’s impair the nerves that control the muscles in the bowel and make them less effective. So do other neurological problems such as multiple sclerosis and stroke (common with vascular dementia). Hypo-thryoidism, or an underactive thyroid gland, decreases hydration and fosters constipation. So does diabetes, very common with seniors in general and especially common with Alzheimer’s. Depression, especially common with LBD and often present in other dementias, can slow down everything, including the GI tract.

Lifestyle can also be a risk factor. The body requires exercise and adequate fluids to function properly and fiber to foster digestion. In our travels, exercise is sometimes limited, and not just when we are traveling from one spot to another. We’ve been in both very warm and very chilly areas. Both make it tempting to stay in our comfortable RV instead of getting out and exercising. Lack of exercise is also often an issue for a person living with dementia, especially if mobility is already a problem. Hydration can be too. Jim has had to learn to drink more water, something he never did as a younger man. This becomes especially important during warm weather. Our bodies need more then. We aren't as careful about what we eat when we travel either, making do with things like fast foods that seldom have much fiber.

Certain medications can also be constipating: sedatives, narcotics, certain antidepressants and those that lower blood pressure. Since many people living with dementia often take these drugs, a care partner needs to be aware of this and be alert for early signs of constipation. Better yet, work with the prescribing physician to use drugs that have less constipation risk…or find an alternative non-drug method of treatment.

OK, so now we know a little about the causes, but what care partners really want to know is how to prevent, identify and treat constipation. Keep tuned. That’s what the next blogs will be about.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.