The Whitworths of Arizona, bringing science to you in everyday language.

Friday, November 2, 2018

Constipation, Pt 2: Prevention

The last blog was about being aware that constipation is not just a condition of dementia but can be caused by other conditions as well. I used Jim’s history of Crohn’s disease as an example but named others such as diabetes as well. However, constipation, even without the complication of anything else can be very serious.

Therefore, the best solution is to prevent the constipation in the first place.
To help prevent constipation,

Avoid refined grains, including white rice, and choose whole grains, especially bran, instead.
Avoid processed foods, including pasta (which Jim loves!) and choose fresh and cooked vegetables (which Jim isn’t as fond of!) instead. These high-fiber foods foster digestion by drawing fluid into the intestinal tract. Warning: if like Jim, Crohn’s is an issue, fiber that is too rough can be problematic. He still adds fiber but avoids foods like popcorn with its rough husks.
Avoid greasy fast foods like burgers and fries. Fatty foods and proteins are low in fiber and take longer to digest. It isn’t so much that they cause constipation as that they take the place of foods that prevent it. Choose nuts, beans and fish instead. If you have a problem getting enough fiber in your loved one’s diet naturally, consider a fiber supplement such as Metamucil or FiberCon.
Avoid processed (white) sugar and bakery items like cookies and cakes. Most people living with dementia love sweets and so avoiding these is often difficult—especially when they make such great bribes! However, these items are triple constipation risks: they are low in fiber, low in fluid and high in fat. Choose fruits instead.

Avoid green bananas but choose ripe bananas. Green bananas are constipating, but ripe ones are great sources of fiber. This is actually true for most fruit although it is especially strong with bananas. Dried fruit make great snacks and have even more fiber than fresh fruit. However, they also have more calories. Remember that old saying about an apple a day keeping the doctor away? You didn’t know they were talking about constipation, did you?

Avoid cheese and ice cream. Choose yogurt and fruit sherbets instead. (Most dairy products are constipating, but yogurt is fermented and has those healthy probiotics.) Also consider fermented foods, such as sauerkraut, kimchi, and miso, all of which contain healthy bacteria and probiotics that assist with digestion. Consider adding a daily probiotic supplement as well.

Avoid cold drinks, including water. Choose warm water instead. Drinking a glassful every morning activates digestion, helps to avoid indigestion and stimulates blood flow. This was a big issue for Jim. He felt good that he was finally drinking more water and then I suggested that he drink WARM water…something he had considered unpalatable in the past. Like a good patient, he manned up and now he drinks it regularly, at least when constipation threatens, although he still doesn’t enjoy it.

Coffee is a stimulant and can foster the digestive process. However, it is also a diuretic which can decrease fluids. Don’t avoid, but drink only a limited amount.

In addition, be sure to exercise regularly and drink water all day long. As we said in the last blog, these two especially can both be issues for summer travelers like us.

Help your loved one to set up a bathroom routine, where you encourage them to move their bowels at the same time of the day, every day. Be especially alert when this routine is broken, as it often is with travel.

Consider a daily routine of a combination of an osmatic laxative, such as Miralax, milk of magnesia or Citroma and stool softeners. The osmatics soften the stool by drawing fluid into the colon from nearby tissue and the stool softeners draw fluid already in the colon into the stool to soften it further. What works for each person varies. Some people need to take both every day. Jim learned that a daily dose of these could lead to diarrhea for him, but that using just the osmatics every other day kept him regular most of the time. Like Jim, you will probably have to learn by experimenting. However, check with the doctor before you start. These laxatives are mild, but they are still drugs and may conflict with something else your loved one is taking.

The next blog is about how to identify the presence of constipation is present in a person with a limited ability to recognize why they are uncomfortable or to communicate this easily to their care partner.

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.

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