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Digestive Problems

• The digestive system is complex and a variety of symptoms may appear when it is not working properly.
• Heartburn, constipation, and diarrhea are the most common digestive problems of older adults.
• The symptoms of these common conditions can be managed at home at first. If the problems continue or get worse, medical care is required.

• Caregivers of older adults deal with a variety of stomach complaints ranging from abdominal pain and swallowing difficulties, through to constipation and diarrhea.
• There are many causes of these problems including diseases, bowel disturbances, infections and medications.
• A digestive problem can be serious in older people. It may cause them to stop eating, which results in weakness and weight loss. These, in turn, can contribute to other problems such as immobility, bedsores and falls.

Heartburn, constipation, and diarrhea are common digestive problems of older adults. Usually the symptoms of these problems can be managed at home. Only if the symptoms persist or get worse is medical attention required.

• Heartburn occurs when stomach acid flows up the esophagus (the tube between the throat and the stomach).
• Constipation involves having fewer than three bowel movements a week, hard stools, and/or straining too hard during bowel movements.
• Diarrhea involves having more than three stools a day and a stool that is loose, watery, or even mucousy.

Heartburn occurs when stomach acid flows up the esophagus (the tube between the throat and the stomach). This is the result of a leaky valve between the esophagus and the stomach. Heartburn is caused by:

• Medications – aspirin, non-steroidal anti-inflammatory medications like Advil or Motrin, osteoporosis medications.
• Foods and drink – chocolate, fatty foods, tomato sauce, mustard, vinegar, citrus fruits and juices, peppermint, caffeine, alcohol.

Symptoms of heartburn include:

• burning or gnawing pain in the upper abdomen, which may be worse after eating or lying down (These symptoms of heartburn are similar to that of stomach ulcers. Medical attention is needed if the symptoms become worse or do not get better with treatment.)
• an acid taste in the throat
• nighttime coughing
• voice hoarseness

The following may help reduce or prevent heartburn:

• avoid medications or foods that cause heartburn
• avoid lying down after eating
• eat smaller meals
• avoid tight-fitting belts or clothing
• raise the head of the bed 10 to 15 cm. (4 to 6 in.)

Over-the-counter antacids, such as Maalox, Gaviscon or Diavol, neutralize the stomach acid, but do not prevent heartburn. If antacids are being used on a daily basis, talk to the physician about more effective medications that lower stomach acid production and prevent heartburn.

• Constipation involves having fewer than three bowel movements a week, hard stools, and/or straining too hard during bowel movements. Constipation can lead to loss of appetite and blockage of the intestine. Constipation can also lead to hemorrhoids and skin tears in the anus, which can cause great discomfort.
• Constipation is a common problem among older people because of aging changes, medications, low fiber and water intake, and lack of exercise or activity. Overuse of laxatives can result in a "lazy" bowel, which makes constipation worse.

• Treating constipation should start with a review of medications. Certain medications, such as some blood pressure pills, water pills, and pain medications, can cause constipation. However, often these medications cannot be stopped and other methods are needed to treat the constipation.
• A high fiber diet with increased water intake can help soften the stool and make it easier to pass. High-fiber foods include bran, fresh fruits, vegetables, beans, and dried prunes (especially effective), apricots and figs.
• Increasing exercise activity will also help reduce the risk of constipation.
• Finally, the urge to have a bowel movement should never be ignored.

• Bulk laxatives are useful, but it is important to drink enough water to make the laxative effective. Bulk laxatives such as bran and psyllium (Metamucil, Fiberpur, Prodiem) can be used daily. Start slowly and gradually increase the amount every few days until bowel movements are normal.
• Sugar-type laxatives, like lactulose, keep water in the colon to help the stool move down the colon. They can cause gas and bloating, but are safe to use daily.
• Saline laxatives, such as Milk of Magnesia, also work by keeping the water in the colon.
• Stimulant laxatives, such as Senokot or Dulcolax, should NOT be used frequently. Long-term use can lead to damage to the nerves in the colon, causing it to become "lazy" and making the constipation worse.

• Diarrhea involves having more than three stools a day and a stool that is loose, watery, or even mucousy.
• Diarrhea can be short-lived or chronic.
• There are many causes of diarrhea, and treatment depends on the cause.

• Infection cause – A viral infection or "stomach flu" is a common cause of diarrhea. There is no treatment other than making sure to avoid dehydration. Diarrhea can also be caused by bacterial infection that results after recent use of antibiotics or hospitalization. Medical care is needed, as treatment involves a specific antibiotic.
• Constipation cause – Severe constipation can cause diarrhea, when liquid stool from higher up in the intestine seeps past the hard stool. This problem will correct itself once the constipation is treated.
• Medication – Many medications cause diarrhea. Review any medications that were started recently.
• Illness cause – Certain diseases such as diabetes, diverticulitis, Irritable Bowel Syndrome, Crohn's Disease and ulcerative colitis are common causes of chronic diarrhea. Treatment involves treating the specific disease causing the symptoms.

• Avoid over-the-counter medications for diarrhea (e.g., Imodium or Pepto-Bismol). These medications prevent the body from getting rid of the toxins that are causing the diarrhea in the first place.
• Focus on preventing dehydration by drinking clear fluids such as water, broths and juices. Maintain a bland diet for a few days until the diarrhea subsides.

Prevent spread of the infection by careful hand washing.


Medical attention for digestive problems is needed when:

• abdominal pain gets worse or lasts longer than several days
• swallowing is painful
• there is choking or coughing when swallowing
• diarrhea lasts for more than one week
• there is persistent nausea and vomiting
• vomit looks like coffee grounds
• stool is bloody, or black and tar-like

Aging in the Know

• This website provides a gateway to health and aging resources on the Internet, including a list of questions you can ask your doctor about disorders of the digestive system.

The College of Family Physicians of Canada

• The College provides a series of topics titled "Ask Your Family Doctor." Topics include Constipation, Diarrhea (although focussed on children), and Heartburn.

American Gastroenterological Association

• Gastroenterologists, or "GIs," are medical specialists with extensive training in diseases of the digestive tract. The AGA's Patient Center provides information about various digestive problems.

Mayo Clinic

• See how your digestive system works: This slide show contains detailed images of the digestive system as well as a desciption of how the digestive system works.
• Heartburn video: This video shows how acid should be retained in your stomach and how it can escape and cause heartburn.
• The Mayo also provides detailed information about constipation, diarrhea and heartburn.

UpToDate

• UpToDate relies on a network of physician authors to produce articles, including topics pertaining to digestive disease.

Canadian Digestive Health Foundation

• This website provides a description of the digestive system, including an interactive drawing, and information about tests to evaluate your digestive health.