Digestive problems in elderly

Digestive Problems as You Age

  • Constipation. One of the most common things we see, certainly as people are getting into their 60s and 70s, may be a change in bowel habits, predominantly more constipation,” says Ira Hanan, MD, associate professor of medicine at the University of Chicago Medical Center. Symptoms include difficult or painful bowel movements, infrequent bowel movements, and hard, dry stool. There are a number of age-related factors that can cause constipation in older adults.
  • Changes in the digestive system. Your digestive system moves food through your body by a series of muscle contractions. Just like squeezing a toothpaste tube, these contractions push food along your digestive tract, Hanan says. As we age, this process sometimes slows down, and this can cause food to move more slowly through the colon. When things slow down, more water gets absorbed from food waste, which can cause constipation.
  • Medication use. Older adults take a lot of medications, says Ellen Stein, MD, an assistant professor of medicine at Johns Hopkins Hospital in Baltimore, MD. And as we age, we start to have more health problems that require medications. Several common medications can cause constipation. One example is calcium channel blockers, used for high blood pressure. “Very good for blood pressure, very constipation causing,” says Stein. Narcotic pain relievers are another common culprit. An older adult who has knee or hip replacement surgery will often be given narcotics for pain. “Narcotics have effects directly on the bowel,” Stein tells Web MD. “They actually slow the gut.”
  • Inactivity. People often become less active as they age, says Stein, and being inactive can make you constipated. Bed rest during an illness can cause real problems. If a person has joint-replacement surgery, for example, it takes time to recover and be fully active again. Add narcotic pain relievers to the mix, and “that might change manageable constipation into something that’s much more of a problem,” Stein says.
  • Not drinking enough fluids. Staying hydrated helps prevent constipation at any age. It can become more of an issue for older adults who take diuretics for high blood pressure or heart failure. Diuretics lower blood pressure by causing you to lose excess fluid by urinating more often. Some people may avoid drinking too many fluids so they don’t have to run to the bathroom all day long. Between urinating more and drinking less, you can become dehydrated.
  • Diverticular Disease. About half of people age 60 and older have diverticulosis. This occurs when small pouches in the lining of the colon bulge out along weak spots in the intestinal wall. While many people don’t have any symptoms, gas, bloating, cramps, and constipation may occur. “I tell my patients its part of the aging of the colon,” Hanan tells WebMD. “As we get older, we’re more prone to developing these pockets.” Why they occur with age is unclear, he says. While most of the time they don’t cause a problem and don’t require treatment, they can cause scarring and irregularity. If the pockets become inflamed, it’s called diverticulitis, which can cause abdominal pain, cramping, fever, chills, nausea, and vomiting. Antibiotics, pain medications, and a liquid diet treat diverticulitis.
  • Ulcers &NSAIDs. Many older adults use nonsteroidal anti-inflammatory drugs (NSAIDs) to control pain from arthritis and other types of chronic pain. Regular use of NSAIDs increases the risk for stomach bleeding and ulcers. So while aging alone doesn’t make your stomach more prone to ulcers, the chronic use of NSAIDs does raise your risk. More often than not older patients don’t have pain from ulcers, says Hanan, but they can have painless gastrointestinal (GI) bleeding. If you notice any type of stomach bleeding, such as vomiting blood, passing dark stools, or noticing blood when you wipe, tell your doctor right away.
  • Problems with the mouth and esophagus. The esophagus is the tube that connects our mouth to our stomach. Like the colon, the esophagus can also slow down with age, moving food through more slowly. This can cause problems swallowing food or fluids. Dementia, stroke, and conditions such as Parkinson’s disease can also cause difficulty swallowing.
  • Polyps. After age 50, the risk increases for developing polyps, or small growths, in the colon. Polyps may be noncancerous, they may become cancer, or they may be cancer. “We don’t know what causes polyps,” Hanan says. There’s been speculation that it’s something in the diet or something we don’t get enough of, plus genetics. It’s probably a cumulative effect over the years, he says. You can have polyps and not know it because they usually don’t have any symptoms. “That’s why screening colonoscopies are recommended for anyone over the age of 50,” Hanan tells WebMD. During this procedure, polyps can be removed before they become cancer. People with a family history of colon cancer or other risk factors may need to have screenings earlier.
  • GERD. Gastroesophageal reflux disease (GERD) is the most common upper GI disorder in older adults, although people of all ages can get it. GERD occurs when stomach acid backs up into the esophagus, causing heartburn and other symptoms. Heartburn is more common as you get older, says Stein, but it’s often caused by factors not related to aging. Eating late at night and eating the wrong types of foods, such as fast food and fried foods, can all cause reflux. Certain medications, including some blood pressure medications, which many older adults take, can cause heartburn. Obesity increases your risk for heartburn and GERD, so if you gain weight as you get older, you could have more reflux.

Anatomy and physiology of ageing 3: the digestive system

The many functions of the digestive system are differently affected by age, making older people more prone to gastrointestinal conditions

Abstract

Ageing can have drastic effects on the functions of the digestive system. One of these is reduced appetite due to changes in hormone production and an alteration in smell and taste. Physiological changes in pharyngeal skills and oesophageal motility may lead to dysphagia and reflux. In the intestines, several factors contribute to changes in the regular gut microbial fauna, making older people more prone to bloating, pain and bacterial infection. There is also a drastic age-associated rise in the incidence of several gut pathologies including cancer of the colon. This third article in our series on the anatomy and physiology of ageing explores the digestive system.

Citation: Nigam Y, Knight J (2017) Anatomy and physiology of ageing 3: the digestive system. Nursing Times ; 113: 4, 54-57.

Authors: Yamni Nigam is an associate professor of biomedical science; John Knight is a senior lecturer in biomedical science; both at the College of Human Health and Science, Swansea University.

  • This article has been double-blind peer reviewed
  • Scroll down to read the article or
  • to see other articles in this series

Introduction

The main role of the digestive system is to mechanically and chemically break down food into simple components that can be absorbed and assimilated by the body. The gut and accessory organs also play an important role in the elimination of indigestible food components, bile pigments, toxins and excess salts. The system performs a range of anatomically and physiologically distinct functions, each of which is affected differently by ageing (Fig 1).

Source: Peter Lamb

The ‘anorexia of ageing’

Food intake diminishes with age due to a range of complex reasons that lead to reduced appetite. These include physiological changes and changes in psychosocial and pharmacological circumstances.

Appetite is controlled mainly by sensors in the gastrointestinal tract, which detect the physical presence of food and prompt the GI tract to produce a range of hormones. These are released before, during and after eating, and control eating behaviours, including the amount consumed. They include:

  • Ghrelin;
  • Peptide tyrosine tyrosine (PYY);
  • Cholecystokinin (CCK);
  • Insulin;
  • Leptin (Pilgrim et al, 2015).

Table 1 highlights the changes that occur in the production of these hormones with advancing age; the overall result is reduced appetite.

We choose what we eat based on the smell and taste of food; however, the number of olfactory receptors decreases with age and the sense of smell diminishes. US research suggests that about half of people aged 65-80 and around three-quarters of those aged over 80 years have a demonstrable loss of smell (Doty and Kamath, 2014).

This decreased sense of smell can have significant safety implications; for example, a disproportionately high number of older people die from accidental gas poisoning. It can also be an early sign of neurodegenerative disorders such as Parkinson’s or Alzheimer’s disease (Hüttenbrink et al, 2013). Olfactory loss – including loss of the ability to discriminate between smells – may also be a consequence of age-related skull bone growth that results in a pinching of sensory nerve fibres.

Most older people experience regional taste deficits in the mouth. However, what is perceived as a taste defect (gustatory dysfunction) is often a primary defect in olfaction – although some studies suggest that age-related changes in the taste cell membranes diminish the sense of taste (Seiberling and Conley, 2004).

The gradual reduction in smell and taste, and therefore in appetite, leads to diminished food intake, possibly resulting in weight loss and malnutrition, while the inability to taste and enjoy food can lead to anxiety. The ability to taste salt also diminishes (Mauk, 2010) and may lead to increased consumption of salt-rich meals, which can aggravate health conditions such as hypertension. Older people should be encouraged to use herbs or mild spices in their dishes, rather than salt, if they need to add flavour.

The mouth

The lips, tongue, salivary glands and teeth all play a role in chewing, breaking down and swallowing food. Age-related shrinkage of the maxillary and mandibular bones and reduction in bone calcium content cause a slow erosion of the tooth sockets, leading to gum recession and an increased risk of root decay (Pradeep et al, 2012). People without teeth (edentulous) or who have poorly fitting dentures may find chewing difficult and, therefore, eat less and become malnourished. Alternatively, they may choose highly refined, easy-to-chew foods, thereby consuming less dietary fibre; this will affect their bowel function, and may cause problems such as constipation.

A dry mouth (xerostomia) is common among older people; Smith et al (2013) showed that healthy subjects aged 70 years and over produced less saliva than younger people. However, while the number of tongue acinar (saliva-producing) cells decreases with age, there is conflicting evidence as to whether the volume of saliva produced also decreases. Xerostomia can be an adverse effect of medication or can result from diseases such as diabetes. Although it is common among older people generally, it is more likely to occur in those who are taking more than four prescription drugs per day (Yellowitz and Schneiderman, 2014). Drug categories that may cause xerostomia include:

  • Diuretics;
  • Antihypertensives;
  • Antibiotics;
  • Bronchodilators;
  • Certain antidepressants.

Swallowing

Having formed a bolus of food, the mouth prepares to swallow. The bolus reaches the posterior pharyngeal wall and the musculature contracts around it; swallowing occurs and food travels through the upper oesophageal sphincter into the oesophagus. With age, the muscular contractions that initiate swallowing slow down, increasing pharyngeal transit time (Nikhil et al, 2014). This may lead to swallowing difficulties (dysphagia), which can increase the risk of choking and the feeling that food is stuck in the throat. Up to 26.7% of people aged 76 years and over experience dysphagia (Baijens et al, 2016).

The oesophagus

In general, the motor function of the GI tract is relatively well preserved in healthy older people, but there are significant changes in oropharyngeal and oesophageal motility. In the very old, impaired oesophageal motility is common; oesophageal peristalsis weakens with age (Gutschow et al, 2011) and peristalsis may no longer be triggered by each swallow. Both upper and lower oesophageal sphincters lose tension; the lower one in particular undergoes a reduction in pressure, resulting in problems such as dysphagia, reflux and heartburn (Grassi et al, 2011). In addition, the gag reflex is absent in 43% of older people (Davies et al, 1995).

The stomach

The stomach acts as a reservoir for food, allowing us to eat at regular intervals. With age, it cannot accommodate as much food, primarily because its wall loses elasticity.

As a normal part of digestion, the stomach secretes gastric juice containing hydrochloric acid and pepsin. Although, in general, older and younger people produce gastric acid at a similar rate (Merchant et al, 2016), acid hyposecretion occurs in 10-20% of older people versus <1% of younger subjects (Gidal, 2007). This can compromise the bioavailability of certain drugs, including vitamin B12, and lead to disorders such as chronic atrophic gastritis.

There is also an age-related reduction in mucus-producing goblet cells, which results in reduced secretion of protective mucus and therefore a weakened mucosal barrier. Consequently the stomach’s lining becomes more prone to damage (Saber and Bayumi, 2016).

Gastric bicarbonate (HCO3-) and mucus normally provide an alkaline layer to defend the stomach lining against gastric juices; however, research suggests that advancing age is associated with a decline in HCO3- secretion (Saber and Bayumi, 2016). The protective prostaglandin content of mucus also decreases with age, making older people more prone to gastromucosal injury such as lesions and ulcers, especially after ingesting non-steroidal anti-inflammatory drugs, which are commonly taken by older people. However, proton pump inhibitors (PPIs), which suppress acid production, are often prescribed alongside NSAIDs (Fujimori, 2015).

Finally, gastric emptying slows down with age; this means food remains in the stomach for longer, prolonging satiation and reducing appetite (Nieuwenhuizen et al, 2010).

The small intestine

The main function of the small intestine is to digest and absorb food. It produces a range of digestive enzymes, supported by the pancreas and liver.

Absorption of nutrients occurs in the jejunum and ileum, the second and third regions of the small intestine. The lining of the small intestine is shaped into microscopic folds (villi), which increase the surface area available for absorption. Although an age-related reduction in villus height has been shown, the impact on nutrient uptake does not seem to be clinically significant (Drozdowski and Thomson, 2006).

There is evidence that the production of the enzyme lactase decreases with age, making older people more prone to lactose intolerance (Di Stefano et al, 2001); lactase is created following instruction from the LCT gene, which becomes less active over time.

Populations of certain bacteria that reside in the small intestine have been shown to increase as we age, leading to bloating, pain and decreased absorption of nutrients such as calcium, folic acid and iron. This can have a negative effect on health. In addition, PPIs have been shown to provoke bacterial overgrowth in the small intestine, which may exacerbate NSAID-induced small intestinal injury and foster the development of systemic conditions, including inflammatory bowel disease, diabetes and autoimmune diseases (Fujimori, 2015).

Peyer’s patches – small nodules of lymphatic tissue that form part of the gut’s immune defence system – monitor populations of intestinal bacteria to prevent the growth of pathogens. However, there is a gradual reduction in the number of Peyer’s patches in the small intestine, accompanied by a gradual loss of lymphoid follicles (Merchant et al, 2016); this can result in an uncontrolled growth of resident micro-flora.

The large intestine

As already mentioned, oesophageal peristalsis slows with age, but research has recently shown that small intestinal transit time does not seem to be affected (Fischer and Fadda, 2016). In contrast, there is an age-related slowing down of colonic transit caused by a decline in propulsive activity of the colon, which is associated with a reduction in neurotransmitters and neuroreceptors (Britton and McLaughlin, 2013). This causes a delay in colonic transit of waste, leading to constipation (Wiskur and Greenwood-Van Meerveld, 2010).

Peristalsis is also affected by the age-related atrophy of the mucosa and muscle layers of the colon. The walls of the colon sag, prompting the formation of pouches (diverticuli). Straining to eliminate faeces may put additional pressure on weakened blood vessel walls, giving rise to haemorrhoids.

The rate of cell division declines in the digestive epithelium, which cannot repair and replace itself as well as it needs to. There is also a drastic age-associated rise in the incidence of several gut pathologies including cancer of the colon – in fact, age is the key risk factor for colorectal cancer. Recent studies indicate that ageing induces changes in the DNA of epithelial intestinal cells, particularly in the colon; this process – known as DNA methylation – is believed to play a significant part in the development of colorectal cancers (Masoro and Austad, 2010).

Gut microbes

Changes in the populations of gut microbes lead to an increase in facultative anaerobes – including streptococcus, staphylococcus, enterococcus and enterobacteriaceae – which are able to thrive in inflamed conditions (Pédron and Sansonetti, 2008). The ageing process mimics the intestinal microbe profile that accompanies inflammatory bowel diseases and obesity (Neish, 2009).

The commensal microorganisms inhabiting the lumen of the colon are prevented from entering surrounding tissues by a single layer of epithelial cells that form an impermeable mucosal barrier. This barrier becomes ‘leaky’ with age (Mabbott, 2015). As the barrier function of the mucosal immune system is impaired, the incidence of GI pathogen infections is higher – and is a major cause of morbidity and mortality in older people (Mabbott et al, 2015). This group is also at increased risk of infection with Clostridium difficile, which causes a potentially fatal dehydrating diarrhoea for which the two major risk factors are age of ≥65 years and exposure to antimicrobials (Jump, 2013).

The accessory organs

With age, the pancreas, which generates four major digestive enzymes, decreases in weight and some of its tissue undergoes fibrosis. Its exocrine function is impaired and the secretion of chymotrypsin and pancreatic lipase reduced (Laugier et al, 1991), adversely affecting the ability of the small intestine to digest food.

The liver undertakes more than 114 functions for the body; as it shrinks with age and blood flow to it decreases, its functional capacity also decreases (Drozdowski and Thomson, 2006). There is a decrease in the rate of protein synthesis and of metabolism, the liver’s ability to detoxify many substances, as well as the production and flow of bile (involved in fat emulsification). In addition, bile becomes thicker and its salt content diminishes, resulting in higher plasma concentrations of cholesterol, particularly in women (Frommherz et al, 2016). Drugs are no longer inactivated quickly by the liver and are therefore more likely to cause dose-related side-effects: dosages therefore need to be carefully checked when prescribing for older people.

Key points

  • In older people, reduced appetite and food intake may lead to weight loss and malnutrition
  • Dry mouth is common in older people and may be a side-effect of a range of drugs
  • Significant changes in gut microbe populations that occur with age increase the risk of bacterial infection
  • With age, peristalsis slows in the oesophagus and the colon, leading to issues such as dysphagia, reflux and constipation
  • Incidence of several gut pathologies, including cancer of the colon, rises with age

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How Aging Affects Your Digestive Health

Aging puts the body at higher risk for an assortment of health ailments and conditions.

With age, many bodily functions slow down, including your digestive tract — it just might not work as efficiently or as quickly as it used to. The muscles in the digestive tract become stiffer, weaker, and less efficient. Your tissues are also more likely to become damaged because new cells aren’t forming as quickly as they once did.

As a result, digestive tract problems that can occur as people age include:

  • Heartburn
  • Peptic ulcers
  • Diarrhea
  • Constipation
  • Hemorrhoids
  • Gas
  • Stomach pain
  • Irritable bowel syndrome
  • Diverticulitis
  • Fecal incontinence
  • Gastroesophageal reflux disease (GERD)

It’s important that you to seek help for any digestive discomforts and not simply brush them off as part of aging.

Seniors may also have unusual symptoms of more serious digestive disorders that can easily be missed. Gastroesophageal reflux disease (GERD) tends to be more serious in seniors, but older adults may show less common reflux symptoms, such as coughing or wheezing, according to the University of Maryland Medical Center.

Aging and Digestion: Medical Conditions

The main reason that aging affects the digestive tract is that aging usually brings on other health conditions — and medication to deal with those conditions.

  • Diabetes and gastroparesis. “As people age, they get diabetes, and that can cause a lot of problems in the bowel,” says Francisco J. Marrero, MD, a gastroenterologist with the Digestive Health Center at Lake Charles Memorial Health System in Louisiana. “They also get gastroparesis — that’s probably the most significant effect of aging on the bowels.” Gastroparesis is a disorder in which food takes a long time to clear the stomach, resulting in many unpleasant symptoms. Gastroparesis tends to be more common in women, notes the American College of Gastroenterology, and causes frequent bloating and nausea.
  • Artery blockages. Dr. Marrero says blockages in older people are also very common. Blockages in arteries can affect blood flow to the bowels, a condition called intestinal ischemia, during which blood flow to the intestines decreases in a fashion similar to what happens with a heart attack. “More systemic problems that are more common with age are really the reason for digestive tract issues,” he explains.

  • Arthritis and hypertension. Many older people also take a variety of medications to manage chronic conditions like arthritis and high blood pressure, and the drugs used to treat both of those conditions can have digestive tract side effects.

“Older people tend to have more joint problems with arthritis and therefore may need medication to treat that,” Marrero says. “They are at increased risk of peptic ulcer disease when they take nonsteroidal anti-inflammatory drugs , a fact often overlooked in people that are prescribed those medications.”

People taking over-the-counter NSAIDs for everyday aches and pains are also at risk of developing ulcers and other digestive tract problems. “They should always be on something to protect their stomachs,” Marrero recommends. Senior women, in particular, are more susceptible to developing an inflammation of the stomach called gastritis, which can result from frequent use of NSAIDs, according to the American College of Gastroenterology.

Aging and Digestion: Think Protection

Fortunately, your digestive tract doesn’t have to become a victim of age. Like the rest of your body, it can often be protected with a healthy lifestyle. If you want to keep your digestive tract in good shape and keep uncomfortable symptoms at bay, try these tips that can make digestion a little easier:

  • Stay hydrated by drinking a lot of water.
  • Limit fats in your diet and maintain a healthy body weight.
  • Load your diet with fiber.
  • Stick to healthy portion sizes and avoid overeating.
  • Get regular exercise.

Healthy living will not only keep your digestive tract healthy but also reduce your need for some of those side-effect-causing medications. You’ll feel young, happy, and healthy — both inside and out.

Aging Digestive Tract

Download a pdf of this aging digestive tract information.

Aging Digestive Tract Overview

The digestive system is a vital collection of organs that is responsible for breaking down food into its components for the body to use. As we age, the risk of something going wrong in the digestive system continues to rise, due to the culmination of years of effects from diet, lifestyle, diseases, and medications. In the elderly individual, new medical issues can arise, such as diverticular disease or colorectal cancer, or the worsening of long-standing conditions, such as dyspepsia, irritable bowel syndrome, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), celiac disease, and GERD.

Here we will look at ways to maintain digestive health as you age, as well as disorders that commonly affect older individuals, and the treatment and management of these conditions.

Dietary and Lifestyle Changes

Maintaining healthy dietary habits can offer great benefits to your overall digestive health. Choose nutritious foods, as outlined in Canada’s Food Guide, and eat a variety of foods. Getting enough fibre is important, to positively influence constipation, diarrhea, and diverticular disease. Women older than 50 years of age should aim for 21 g of fibre a day, and men in that age group should aim for 30 g. Getting enough vitamin D is also vital, especially during the winter, and our needs increase as we age. Those who are aged 51-70 should take 400 IU (10 micrograms) of vitamin D per day, and those who are 71 years and older should take 600 IU (15 micrograms) per day. Supplements are absolutely necessary, because we do not have enough dietary sources, and we do not get enough sunlight year-round in Canada to synthesize our own vitamin D. Calcium intake is also very important for the elderly, who should aim to consume 1,200 mg of calcium per day, by consuming three servings of dairy or alternatives per day, or through supplements.

It is important to remain active throughout life. A person who is older than 50 should take part in at least two and a half hours of moderate to vigorous intensity aerobic activity each week, spread out into sessions of ten minutes or more. This can include activities such as walking, biking, and swimming. Add muscle and bone strengthening activities at least twice a week.

Getting enough sleep can also benefit digestive health and function, so it is important to get enough hours in. Stress can also contribute to worsening digestive symptoms, and while it is easier said than done, focusing on relieving stress can help you maintain good health. Some techniques for managing stress include regular exercise, taking time for yourself, having a good belly laugh, becoming a better breather, and monitoring negative thoughts. For more information on this, ask for our Stress Management pamphlet or search for this on www.badgut.org.

Dysphagia

Difficulty swallowing (dysphagia) is common in older individuals. There are a few things that contribute to this, including reduced saliva production, reduced strength in the upper esophageal sphincter, degeneration of nerves and muscles (which is a common consequence from Parkinson’s and stroke), and impaired coordination of the process of swallowing. These symptoms become more frequent as we age. If you experience difficulty swallowing, there are a few techniques to mitigate symptoms. Thorough chewing, good dental health, properly fitting dentures, eating slowly, and sitting upright while eating can all help.

Functional Dyspepsia

Functional dyspepsia (FD) is a chronic disorder of sensation and movement (peristalsis) in the upper digestive tract that affects approximately 20-45% of the population. Symptoms include recurrent upper abdominal pain, nausea, belching, bloating, early fullness, and indigestion. The cause of functional dyspepsia is unknown; however, several hypotheses could explain this condition even though none can be consistently associated with FD. Excessive acid secretion, inflammation of the stomach or duodenum, food allergies, lifestyle and diet influences, psychological factors, medication side effects (from drugs such as non-steroidal anti-inflammatory drugs and aspirin), and Helicobacter pylori infection have all had their proponents. To learn more, ask for our pamphlet on Functional Dyspepsia.

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) occurs when the upper portion of the digestive tract is not functioning properly, causing stomach contents to flow back into the esophagus. The most common symptom of GERD is acid reflux, and other symptoms include heartburn, acid or food regurgitation, persistent sore throat, chronic coughing, chest pain, and bad breath. 13-29% of Canadians experience recurring symptoms. To learn more, ask for our pamphlet on Gastroesophageal Reflux Disease (GERD).

Management of Dyspepsia and GERD

The management for these two upper GI disorders is similar. They involve a combination of dietary and lifestyle modifications, and medications where needed. It is important to find your own trigger foods, which are foods that make symptoms worse whenever you consume them. Some common trigger foods for FD and GERD are fatty foods, spices, alcohol, and caffeine, but each individual is unique and you may find that these foods don’t bother you, but other foods do. Avoiding these foods, or consuming them only in small quantities, can help manage symptoms. Maintaining a healthy body weight and quitting or reducing cigarette smoking can also help, because obesity and nicotine can contribute to lower esophageal sphincter malfunction. Avoid lying down right after eating, and try elevating the head of the bed by six inches while sleeping.

There are two main types of medications that help reduce heartburn. There are those that neutralize acid, such as Maalox®, Tums®, and Pepto-Bismol®. These are generally only for short-term (two weeks or less) use. The other kinds of medication are those that suppress acid secretion, and are used for long-term GERD management. These include H2RAs (Pepcid®, Tagamet®, Zantac®) and PPIs (Losec®, Pantoloc®, Prevacid®, Nexium®, Tecta®, Dexilant®).

NSAID Complications

Non-steroidal anti-inflammatory drugs (NSAIDs) are a type of pain relief medication. The most common of these are acetylsalicylic acid (Aspirin®, ASA), ibuprofen (Advil®), and naproxen (Aleve®). While these medications are effective at relieving pain, and come with a relatively low side effect profile, they can cause damage in the upper digestive tract. As you get older, your risk of developing complications such as gastric ulcers increases. Other risk factors include high doses or frequent use of NSAIDs, prior GI bleed, concomitant steroid use, cardiovascular disease, and mixing multiple NSAIDs. To prevent gastrointestinal damage from NSAIDs, you can take certain medications, such as H2RAs and PPIs, which reduce the acid in your stomach, or a mucosal acting shield (Sucralfate®) to protect the stomach from acid. There are also alternative NSAIDs, such as COX-2 inhibitors (Celebrex®), but these have their own risks. If none of these options work, you might consider limiting or avoiding NSAIDs. If you have any concern about your NSAID use and its potential complications, please speak with your physician.

Bowel Habits – What’s Normal?

Normal bowel habits vary from person to person, and the important thing to focus on is your comfort level. Typically, having a bowel movement three times a day to three times a week is considered normal, but if you fall within this range and have unpleasant symptoms, it might not be healthy for you, and if you fall outside of this range, but with no other symptoms, you might be fine. A healthy bowel movement will pass smoothly and without pain, and is not too loose and watery or too hard and lumpy. You shouldn’t have to strain, and when you have to go, it should not be uncomfortably urgent.

Diarrhea

Diarrhea occurs when the digestive tract pushes matter through it too quickly (fast colonic transit time). This means that there is not enough time for the large intestine to adequately remove water out of the colon, and it leads to increased fluid, volume, and frequency of bowel movements. Abdominal discomfort is also quite common. There are many causes of diarrhea, some are temporary effects and some are from chronic disease. Examples include infection, medication side effects, lactose intolerance, celiac disease, irritable bowel syndrome, and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Diarrhea affects approximately 7-14% of seniors.

Managing Diarrhea

There are two groups of medications that can help ease diarrhea.

The first group, bulk formers, work by soaking up water in the bowel to reduce stool looseness and frequency. These include fibre or psyllium (Metamucil®, Prodiem®, Benefibre®) and bile salt binders (Olestyr®).

The second group includes medications that alter the muscle activity of the intestine, slowing down transit time, allowing the intestine to absorb more water from the stool. These include non narcotic anti-diarrheal agents such as loperamide (Imodium®), narcotic anti-diarrheal agents such as Lomotil® and codeine, and anti-spasmodic agents such as Buscopan®.

Constipation

Constipation occurs when fecal matter takes too long moving through the digestive tract (slow colonic transit time). This leads to the large intestine absorbing excess water from stool, creating hard, dry stools, reduced frequency, straining, rectal pressure or fullness, bloating, abdominal pain, and a sensation of incomplete evacuation. These symptoms can lead to poor appetite, back pain, and general malaise. Causes include consuming a diet that is too low in fibre and fluid, insufficient physical activity, medication side effect (opiates, tricyclic anti-depressants, calcium channel blockers), certain supplements (calcium and iron), irritable bowel syndrome, intestinal obstructions or strictures from surgery, diabetes, stroke, hypothyroidism, and Parkinson’s. Constipation affects 15% of the Canadian population, but is much more common in older individuals, affecting 13% of those age 30-64, and 23% of those age 65-93.

Managing Constipation

A combination of lifestyle and dietary modifications can help ease constipation in many cases. Consuming adequate fibre, and ensuring that you consume plenty of fluids adds bulk to the stool, which makes it move more quickly through the digestive tract. Prunes are a high-fibre food that are effective at treating constipation, and contain nutrients for general good health.

Getting enough physical activity can also help move the stool through the colon more quickly. You can also reduce complications of constipation, such as hemorrhoids, by ensuring that you take your time in the bathroom, and avoid straining. Keeping your feet slightly elevated, and leaning forward, can put your colon in a more ideal position for comfortable stool passage.

When these lifestyle changes aren’t enough, there are many medications that can help speed up transit time to prevent and relieve constipation. These include a wide variety of laxatives, such as stool softeners, lubricants, stimulants, and hyperosmotics, including saline, lactulose, glycerin, and polymer. Enemas can also help some individuals.

In more severe cases, a prescription medication called linaclotide (Constella®) can improve stool consistency by increasing intestinal fluid secretion. This helps ease the passage of stool through the digestive tract and relieve associated symptoms.

Diverticular Disease

Diverticular disease occurs when small sac-like out-pouchings that balloon through the outer colon wall form in the colon lining. These out-pouchings, called diverticula (diverticulum if it is only one) are typically 0.5-1 cm in diameter, but can become much larger in rare cases. They are most frequently found in the lower section of the colon. Diverticular disease is a disease of the elderly. It affects 5% of the Western adult population younger than 40 years of age, but affects 50% of those who are aged 60 years and older, and rises to 65% in those who are 85 years of age and older.

There are two main states in diverticular disease: diverticulosis and diverticulitis. Diverticulosis occurs when there are diverticula present, but they are not inflamed. It is often present without symptoms (85% of the time), and can be managed through healthy dietary habits, including adequate fibre and water intake, and moderate exercise. Diverticulitis occurs during a flare-up, when the diverticula become inflamed and/or infected, and occurs in 10-25% of diverticular disease cases. Symptoms can include an increase in diarrhea, cramping, and bowel irritability, as well as bleeding, bloating, fever, and intense pain and tenderness in the left lower portion of the abdomen. Treatment for diverticulitis involves a low-fibre or liquid diet to allow for bowel rest, and sometimes antibiotics or surgery are necessary. To learn more, view our video on diverticular disease.

Colorectal Cancer

Colorectal cancer is a serious, life-threatening disease. It is more common in the elderly than in young people, but still has a low lifetime risk of development. Approximately 5-6% of the population develops colorectal cancer, and it is more common in men than in women. Individuals who have had ulcerative colitis or Crohn’s disease in the colon for more than ten years, and those with a family history of colorectal cancer are also at an increased risk. While it is a devastating disease, if caught early, treatment is very effective.

It takes up to ten years for colorectal cancer to develop from a polyp. This is why the recommendation of a colonoscopy every ten years is effective. This allows physicians to remove any risky polyps before they can become cancerous. Another option is to have an annual or bi-annual stool test, then if your physician sees anything abnormal he or she can recommend a colonoscopy. Just make sure to get tested! However, most physicians advise the cessation of colon screening once you reach the age of 75 years or if you are experiencing significant health issues.

Warning Signs

If you experience a recent/sudden onset of the following symptoms, discuss with your doctor:

  • bleeding/anemia
  • unplanned weight loss
  • fever
  • nocturnal bowel movements
  • family/personal history of colon cancer

Outlook

While your risk of developing digestive diseases and disorders increases moderately as you age, a well balanced diet, exercise, and letting your physician know of any sudden changes in your digestive system can all go a long way in maintaining healthy function well into those wiser years.

Image Credit: © bigstockphoto.com/Rohit

The “tummy aches” you may have had as a child can evolve into a long list of digestive problems as you age. They’re annoying, but the good news is that things like acid reflux and constipation are irritations that you can treat. Often, simple lifestyle changes will do the trick.

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“Many older adults fixate on their gastrointestinal problems,” says gastroenterologist Maged Rizk, MD. “The gastrointestinal tract ages with the rest of us. I tell patients not to get too upset by it.”

Older adults and digestive ailments

Medicine, inactivity and even gravity all can take their toll and contribute to digestive troubles as you get older, Dr. Rizk says.

Here, according to Dr. Rizk, are the main culprits and the symptoms they cause:

  • Multiple medications — These may cause a variety of gastrointestinal issues, including constipation, diarrhea, abdominal pain, nausea and bleeding ulcers.
  • Inactivity and dehydration — These issues are more common as you age and they can make constipation worse.
  • Gravity — Over time the diaphragm can sink, causing decreased support where the esophagus joins the stomach (a hiatal hernia). And it typically causes heartburn and reflux. Medication often helps, but surgery is sometimes needed.
  • A weakened sphincter muscle, sedentary lifestyle and chronic constipation — These all may contribute to cause hemorrhoids, which are swollen veins in the lower gastrointestinal tract. Hemorrhoids are common in older adults.

What role does diet play?

Your eating habits also likely change as you age.

You may no longer have the interest or energy to prepare a well-balanced, high-fiber meal or to cut up fresh fruits and vegetables, especially if you eat your meals alone. And food may no longer be as pleasurable and tasty as it once was.

“When we are infants, we have the most taste buds, and they gradually reduce in number as we get older,” Dr. Rizk says.

An unbalanced diet can cause iron, B-12 and other vitamin deficiencies, which in turn result in digestive problems.

5 steps to improve your digestion

Aging may spur digestive issues, but Dr. Rizk says there are steps you can take to counteract those challenges. His five best tips:

1. Maintain a healthy diet.

  • Add fiber to meals by including raw vegetables, fruits and whole grains.
  • Reduce salt consumption.
  • Avoid “white foods” such as bread, rice and potatoes.
  • Drink water or other non-caffeinated, non-alcoholic beverages throughout the day so your urine is almost clear.

2. Avoid foods that trigger heartburn or reflux. Try an elimination diet if you are uncertain about which foods cause issues for you. “It’s different for everyone,” Dr. Rizk says.

3. Consider a probiotic. Probiotic supplements, which contain helpful “good” bacteria, sometimes can aid people with chronic constipation. However, Dr. Rizk does not recommend taking them for diarrhea unless it is after specific types of infections.

4. Check your medications. Over-the-counter and prescription drugs can cause digestive problems. Talk to your doctor about possible side effects. And ask for a substitute if a medicine is causing nausea, diarrhea, constipation or other concerns.

5. Stay active. Exercise and physical activity offer lots of health benefits, including preventing constipation.

Aging may throw you some annoying curve balls. Following these tips will go a long way toward improving your digestion and limiting your tummy troubles as you age.

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