Constipation Prevention for Dementia

People living with dementia can be more vulnerable to constipation

Although anyone can become constipated, people living with dementia can be more at risk due to:

• Moving less
• Chronic stress
• Drinking less fluids
• More difficulty making it to the bathroom
• Difficulty communicating needs
• Diet changes
• Not chewing food as thoroughly
• Difficulty feeling sensation of having to have a bowel movement

What is constipation and why it matters

Constipation is defined medically as having 5 or fewer bowel movements a week. The longer stool stays in the colon, the more time bacteria have to grow in the stool. We all have bacteria in our digestive tract, and they have an important job: fermenting fiber, supporting metabolism, and synthesizing vitamins before waste is passed outside the body. Some of these bacteria are known as “gram-negative” bacteria. These bacteria have a unique shield that protects them from dying in a low-oxygen environment such as the colon. When these bacteria grow too large in population and eventually die, their abandoned shields leave behind a toxin called lipopolysaccharide (LPS).

Constipation can lead to the overproduction of this gram-negative bacteria. An abundance of LPS produced by the gram-negative bacteria can escape the gut and reach the circulatory system. In healthy individuals, this bacteria remains in the gut and any stragglers are taken care of by the immune system. But in a metabolically stressed body, these toxins can overwhelm the immune system. Increased rates of constipation have an association with dementia¹. You can read more about how immune stressors affect the brain here. Constipation can lead to needless pain, increased irritability, difficulty sleeping, agitation, and reduced appetite for those living with dementia. Maintaining daily bowel movements can free up resources for rest, repair, and daily activity.

Preventing constipation for dementia

It is much easier to prevent constipation than to resolve it after it begins.

Laxatives can force the bowels to move if constipation is already present. However, this will not resolve the underlying causes, and regular use of laxatives has been linked to higher risk of dementia².

To reduce the risk of becoming constipated in the first place, the following prevention strategies can help restore the relaxed, wave-like muscle motions that move matter through the digestive tract (peristalsis).

Dietary & nutritional support

• Drink coffee
  The old adage is true: Coffee can indeed make you poop.³. Both regular and decaf can stimulate bowel movements in some people.
• Prune juice
  Prune juice is an old standby, for good reason.⁴.
• Take MCT oil
  One half teaspoon with meals can ease bowel movements⁵ Add to food or beverages only after cooking. Do not cook with MCT oil.
• Eat raw carrots
  Eating 2-3 shredded carrots a day has been found to increase stool output⁶.
• Salt your food
  Adequate salt intake supports normal fluid balance⁷. Unless you have been directed by your physician to be on a low-salt diet, do not be afraid to salt food to taste.
• Alternative fluids
  If cold drinks are not tolerated well, warm broth can be a way to support hydration. If thin fluids are not well tolerated, gelatin can be helpful for fluid balance.
• Drink bone broth (or eat jello)
  To support hydration, especially if drinking cold fluids is difficult, glycine, which promotes relaxation of the gut⁸. Both can be eaten daily.
• Enjoy fruit
  Increased fruit intake is associated with reduced frequency of constipation⁹.

Movement & timing

• Gentle movement
  Encourage walking or standing hourly while awake if able. This promotes circulation and gentle movement of the gut. If walking is not tolerated, gentle abdominal massage can help, click here for instructions. Review¹⁰
• Go at the right times
  Plan a bathroom trip within a half hour of waking and about a half hour after a heavy meal. It is easier to pass stool at these times.