Constipation is very prevalent at end-of-life and is a common side effect of narcotic pain medications such as codeine, morphine and other opioids. Being inactive and consuming insufficient fluids also contributes to reduced intestinal motility.

Chronic constipation is frequently a major contributor to loss of appetite which may be accompanied by gas, bloating and nausea. Drinking sufficient fluids is very important to maintaining normal bowel function. Without adequate fluid intake, high-fiber foods and supplements can make constipation worse and may even result in a dangerous and painful intestinal blockage.

Promoting Healthy Bowel Function

  • Try to take in 8 to 10 cups of liquid each day. High water-content fruits such as melons and grapes can make up some of this fluid and supply fiber as well.
  • Eat a breakfast that includes a hot drink and high-fiber foods.
  • Try to eat at the same times each day. Have a meal and snack schedule.
  • Avoid constipating foods such as fried foods and cheese.
  • Try to go for a daily walk or be physically active in some way. Even 10 minutes at a time helps. Weak abdominal muscles can be a contributor to sluggish bowel function.
  • Try to eat at least 5 servings of fruits and vegetables a day.
  • Supplement the diet with probiotic bacteria for gastrointestinal health.

Special Points of Interest:

  • Sufficient fluids are essential for proper bowel function.
  • Eat plenty of fruits, vegetables and whole grains daily.
  • Regular physical activity helps maintain bowel function.
  • Supplementing with beneficial bacteria can promote regularity.
  • Fiber supplements composed of psyllium seed are not nearly as helpful as wheat bran.
  • Chronic constipation may require a combination of strategies to effectively resolve.

Activia Yogurt

Activia contains Bifidobacterium animalis DN-173 010, an exclusive probiotic culture developed by Dannon. They term it Bifidus Regularis reduces constipation and promotes bowel regularity by shortening transit time. Transit time is defined as the average amount of time it takes for intestinal contents to pass through the digestive system. Transit time is affected by age, diet, state of health, stress and the balance of intestinal microflora.

Two clinical trials done on Activia with elderly subjects demonstrate that consumption of 1 to 3 cups daily for 2 weeks is effective in reducing intestinal transit time. A 40 percent reduction in transit time was found in those who whose gut transit was greater than 40 hours.

When subjects ceased taking Activia, the probiotics continued to exert their beneficial effect for dose dependent amounts of time. In the case of one daily serving, the transit-shortening effect of Bifidus Regularis persisted for at least two weeks after the end of consumption. The bacteria remained active for four weeks after ceasing consumption in those who ate two daily servings.

Fiber

Increasing the fiber content of the diet is one of the most effective methods of promoting regularity.
Here are some ways to add roughage to meals and snacks:

  • Use whole wheat flour instead of white
  • Purchase whole grain breads and cereals. (Make sure the first word on the ingredient list is “whole” wheat flour equals white flour.)
  • Use brown rice instead of white.
  • Eat fresh fruit instead of juices
  • Beans, seeds and nuts are very high in fiber.
  • Popcorn has much more fiber than chips.

The addition of bran is a simple way to increase dietary fiber. Wheat bran is more helpful in relieving constipation than the majority of over-the-counter fiber supplements. They are primarily composed of psyllium and other forms of soluble fiber that aid in reducing cholesterol. The fiber in bran has the effect of speeding intestinal contents through the digestive tract.

There are a number of high-fiber bran cereals on the market. In addition, unprocessed bran may be purchased from a health food store, and it can be added to foods in many ways.
Here are some ideas for using bran:

  • Add a spoonful to smoothies and shakes
  • Add a little to a bowl of soup
  • Use bran as a breading for fish or meat
  • Add it to meat loaves, hamburger and casseroles
  • Add a spoonful to a bowl of cereal
  • Substitute bran for ½ to 1 cup flour in recipes for cookie, muffin and bread.

Oriental Probiotics

Iichiroh Ohhira, PhD, is an award-winning microbiologist from Japan who developed a premier probiotic formulation in the 1980’s called OMX-12+. It is distributed in the United States by Essential Formulas and is available in two forms, original and professional.
The enteric-coated capsules contain:

  • 12 strains of beneficial bacteria
  • Naturally occurring fructo-oligosaccharide prebiotic fibers
  • Four organic acids which aid bacterial adhesion to intestinal walls and help establish the proper pH environment in the colon
  • Vitamins, minerals, amino acids and an abundance of plant-based micronutrients

Ninety-two species of vegetables, fruits, seaweed, roots, mushrooms, bark, leaves and herbs contribute to the manufacture of this product. The proprietary formulation is fermented together for 3 to 5 years with 12 strains of lactic acid bacteria in a 3-part process.

The resulting probiotics are able to restore the balance of intestinal microflora and aid in the digestion and absorption of nutrients. The encapsulation process that Dr. Ohhira developed results in a shelf life of more than three years without refrigeration.

OMX-12+ has been studied in a number of clinical trials with approximately 1,250 randomly-selected participants at Okayama University in Japan. It has been shown to improve bowel function in addition to many other significant health benefits.

There are a few noted contraindications to the use of probiotics in the medical literature. In the following cases, taking probiotic supplements (such as capsules or liquid not food sources like Activia) may be hazardous:

  • Patients at risk for opportunistic infections
  • Those with badly damaged digestive tracts
  • Patients with acute pancreatitis

In Summary

Constipation is one of the primary complaints of elderly persons and much more so at end-of-life. There are many types of stool softeners, laxatives and enemas that can alleviate the symptoms and bring relief. It may take a combination of stratagems – dietary, lifestyle and medications to manage chronic constipation.

For Further Information:

21st Century Probiotics. (2008) Ecology Health Center [Online]. Available:
http://www.crohns.net/Miva/education/articles/gittleman_21stcenturyprobiotics.shtml.

Scientific Study for Healthcare Professionals. (2008) Activia.com [Online]. Available:
http://activia.us.com/probiotics-benefits.

Constipation. (2008) Medicine Net [Online]. Available:
http://www.medicinenet.com/constipation/article.htm