There’s nothing worse than not being able to go to the bathroom, and while poo isn’t a topic many people feel comfortable talking about, the truth is that everyone experiences constipation at one point or another. The condition leaves some people unable to go to the toilet at all, while others may experience pain and discomfort when they are able to pass stools – however there are effective ways to treat it.
Constipation can impact people of all ages, but there’s an array of reasons why older adults may be at greater risk of developing it, including certain medications, diet and lifestyle factors and pre-existing health conditions. Experts say it’s usually a combination of factors that work together to slow down bowel movement, then causing constipation.
“Medication and lifestyle factors are large contributors to constipation in older adults, with many pain medications, anti-Parkinson’s drugs, antidepressants, antiemetic drugs, antihistamines, antihypertensive drugs and some chemotherapeutic agents causing constipation,” Dr Hannah Wardill, postdoctoral research fellow at the University of Adelaide, told Starts at 60. “As we age, we tend to also eat less varied food – particularly if in a nursing home – with low fibre and highly processed food associated with higher rates of constipation.”
One of the biggest shifts in medicine-related constipation has come from the rapid rise of GLP-1 receptor agonist medications – drugs like Ozempic, Wegovy, Mounjaro and Zepbound, commonly used for type 2 diabetes and weight management, and increasingly taken by Australians in their 60s and beyond.
These medications work partly by slowing gastric emptying – the rate at which food moves from the stomach into the small intestine – which helps people feel fuller for longer. But that same slowdown can extend through the entire digestive tract, meaning stool moves more slowly and the colon has more time to absorb water from it, resulting in harder, drier stools that are more difficult to pass.
Clinical trial data gives a sense of scale: in trials for semaglutide (Wegovy) at the higher weight-loss dose, roughly a quarter of participants reported constipation, compared to around one in ten of those taking a placebo. Similar rates have been reported in trials of tirzepatide (Mounjaro/Zepbound). For most people, this side effect is manageable with the same fibre, hydration and exercise-based approaches used for other forms of constipation, but it can be more persistent than constipation caused by other medications, and tends to be most pronounced in the first few months of treatment or after a dose increase.
If you’re taking a GLP-1 medication and experiencing new or worsening constipation, it’s worth mentioning to your prescribing doctor rather than assuming it will resolve on its own – particularly given how commonly these medications are now prescribed alongside other drugs already known to contribute to constipation, such as antihypertensives.
Fibre is found naturally in many fruits, vegetables, grains, beans and legumes and, because it’s hard for the stomach to break down, it actually helps to keep the digestive system moving. Soluble fibre is found in many legumes, fruits, vegetables and oats and is considered better for constipation than insoluble fibre found in whole grains, nuts, seeds and bran. Resistant starch, a third type, promotes the production of good bacteria and improves overall bowel health, and is found in foods such as pasta and rice.
“Soluble fibre allows more water to remain in the stool, making it softer and easier to pass,” Wardill explains. “Fibre also helps support a diverse and healthy microbiome [all of the genetic material within the collection of microorganisms in the gut] by providing a nutrient source for the bacteria that reside in our guts.”
Specific foods that are high in fibre that may assist with constipation include pears, apples, berries, green vegetables, carrots, legumes, grains, nuts and seeds, and should replace foods that are highly processed or high in fats and sugar.
“All the fruits and vegetables are the best place to start, but you’ve got all the lentils and chickpeas and people joke about beans and things like that in terms of flatulence but they’re going to help you be regular as well,” nutritionist Rick Hay explains. “I would put in there even herbal teas because they give you more fluid and they can end up helping as well.”
Grapes and prune juice are also high in fibre and hydrating, while leafy green vegetables are high in magnesium, which can also help with bowel movements.
It’s also common for exercise to be prescribed as a first line of therapy for constipation, with research showing that low-impact exercises such as walking, cycling and yoga may have significant benefits for constipation relief, though the real effect of the intervention can’t be definitively determined without further research.
“While the evidence for exercise doesn’t scream any sort of clear consensus, it’s certainly recommended in the management of constipation,” Wardill says. “I think the variability likely comes from the varied nature of constipation causes, and the fact that exercise contributes one of many parts of constipation aetiology.”
Hay adds: “The results of exercise should happen within about two weeks. Even something like a gentle walk is going to relax you.”
When diet or lifestyle changes don’t improve constipation, experts may then look at other possible causes, such as health problems including diabetes, hypothyroidism, menopause, hormonal changes, or neurological disorders such as dementia or Parkinson’s. It’s also possible for psychological factors including stress, depression and anxiety to slow down bowel movement, which can be exacerbated by sedentary behaviours and antidepressant use.
In these cases, treatments specific to individual circumstances may be offered, and laxatives may also be suggested. Still, it’s important not to rely too heavily on them.
“Overuse of laxatives can also be a common problem. Older people can fear constipation, and thus take high amounts of laxatives in an attempt to prevent it from occurring,” Wardill says. “Before too long, they become dependent on laxatives and normal GI [gastrointestinal] function and transit can become sluggish and slow.”
If problems persist and diet or lifestyle changes aren’t having an impact, it’s always important to discuss symptoms with a GP or a gastroenterologist. In cases where a pre-existing health condition – or a medication such as a GLP-1 drug – is contributing to constipation, typical diet or lifestyle changes may need to be combined with medical guidance rather than relied on alone.
“Know that things slow down when you get older. You may not be as regular as you once were,” Hay says. “You’re going to be aiming for one bowel movement a day.”
This article is of a general nature and is not personalised health advice. Before making a health-related decision, work out if the information is appropriate for your situation and seek professional medical advice.
IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.
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