Anxiety in Elderly Patients with Constipation: Causes and Solutions

Elderly individuals experience high anxiety regarding "not having a regular daily bowel movement."

My father is 82 years old and has been experiencing significant anxiety about bowel movements for the past year.
If he does not have a bowel movement early in the morning, he is afraid of missing the urge and does not dare to leave the house all day, avoiding any activities and waiting anxiously.
During this waiting period, he often furrows his brow and appears distressed, sometimes mumbling phrases like "I am useless," "I can't remember anything," and "I have no strength," which causes great concern for the family.
However, once he successfully has a bowel movement, his mood returns to normal.
Additionally, due to his fear of not being able to pass a large stool, his food intake has decreased significantly.
Although there is a table full of food, he only wants to eat what he considers "safe" foods that he believes will not cause him to have difficulty passing stool.
The family's concern and advice have only made him more resolute in his choices.
With reduced activity and decreased food intake, he has developed issues such as insomnia (which is being managed with sleep aids) and muscle weakness, creating a vicious cycle that has worsened his quality of life.
Six months ago, he underwent an endoscopy, which diagnosed him with gastroesophageal reflux disease.
His stomach pain is somewhat alleviated with medication, and he is currently under control.
However, constipation continues to trouble him.
He has consulted both gastroenterology and family medicine, and the doctors have stated that as long as there is no feeling of incomplete evacuation or inability to pass stool, having bowel movements 2-3 times a day or every 2-3 days is within the normal range and does not necessarily indicate constipation.
They advised him to increase his activity level and consume more fiber and fats, but his anxiety about the aforementioned issues continues to affect his daily life.
Sometimes he requests family members to perform enemas for him, but he is also concerned that this may become a habit and that the muscles responsible for voluntary bowel movements may lose their function.

I would like to ask: What could be the possible causes of my father's anxiety regarding "constipation" (is it pseudo-constipation?)? Is it related to dementia? How can the family assist him? Which specialty should we consult for further evaluation?

Zoe, 50~59 year old female. Ask Date: 2023/12/24

Dr. Jiang Junyi reply Neurology

Dear Ms.
Zoe,
You mentioned, "What could be the possible causes of anxiety related to 'constipation' (pseudoconstipation)? Is it related to dementia? How can family members assist? Which specialty should we consult?" Anxiety can activate the sympathetic nervous system, exacerbating constipation.
If the issue is due to cognitive impairment or anxiety, it is advisable to seek evaluation and assistance from a psychosomatic medicine specialist.
Certain "cognitive impairments" can be caused by specific treatable conditions, which may offer a chance for recovery.
Examples include:
1.
Nutritional deficiencies: such as a lack of vitamin B12 or folate.
2.
Intracranial lesions: such as normal pressure hydrocephalus, brain tumors, or brain injuries.
3.
Metabolic disorders: such as hypothyroidism or electrolyte imbalances.
4.
Central nervous system infections: such as syphilis or HIV.
Thank you for your inquiry, and I welcome further discussion.
Wishing you and your father good health, safety, and happiness.
Sincerely,
Dr.
Jiang Junyi
Taoyuan Medical Center

Reply Date: 2023/12/24

More Info

Understanding anxiety in elderly patients, particularly those experiencing constipation, is a multifaceted issue that requires careful consideration of both psychological and physiological factors. Your father's situation, characterized by significant anxiety surrounding bowel movements, is not uncommon among older adults. This anxiety can stem from various causes, including past experiences, fear of loss of control, and the physical discomfort associated with constipation.

Causes of Anxiety Related to Constipation
1. Fear of Incontinence or Loss of Control: Many elderly individuals develop a fear of not being able to control their bowel movements, which can lead to anxiety. This fear can be exacerbated by previous experiences of constipation or incontinence, leading to a heightened state of alertness and anxiety when it comes to bowel habits.

2. Cognitive Decline: As individuals age, cognitive decline can occur, which may contribute to anxiety. Your father's statements such as "I have no use" or "I can't remember anything" may indicate feelings of helplessness or depression, which can be linked to both anxiety and cognitive issues.

3. Physical Discomfort: The physical sensations associated with constipation, such as abdominal pain or bloating, can lead to increased anxiety. The anticipation of discomfort can create a cycle where the fear of pain leads to avoidance behaviors, such as not wanting to leave the house.

4. Social Isolation: The anxiety surrounding bowel movements can lead to social withdrawal, as your father may avoid situations where he feels he cannot manage his bowel health. This isolation can further exacerbate feelings of anxiety and depression.

Potential Links to Dementia
While your father's anxiety about constipation does not directly indicate dementia, it is essential to monitor cognitive function closely. Anxiety and depression can sometimes mimic or mask cognitive decline, and persistent anxiety can contribute to cognitive impairment over time. If there are additional signs of memory loss or confusion, it may be prudent to consult a neurologist for a comprehensive evaluation.

Family Support Strategies
1. Encouragement of Healthy Habits: Encourage your father to engage in regular physical activity, as movement can stimulate bowel function. Gentle exercises, such as walking, can be beneficial. Additionally, a diet rich in fiber and adequate hydration can help alleviate constipation.

2. Routine and Environment: Establishing a regular routine for meals and bathroom visits can help reduce anxiety. Creating a comfortable and private bathroom environment may also help him feel more at ease.

3. Addressing Fears: Open communication about his fears and anxieties can help. Reassure him that it is normal to have concerns about bowel health and that many people experience similar issues. Discussing his fears with a healthcare professional may also provide him with reassurance.

4. Professional Help: Given the complexity of your father's symptoms, it may be beneficial to consult a geriatrician or a gastroenterologist who specializes in elderly care. They can provide tailored advice and treatment options for managing constipation and associated anxiety.

5. Mental Health Support: If anxiety persists, consider involving a mental health professional. Cognitive-behavioral therapy (CBT) can be effective in addressing anxiety and helping him develop coping strategies.

Conclusion
Your father's anxiety about constipation is likely a combination of physical discomfort, fear of loss of control, and potential cognitive decline. By addressing both the physical and psychological aspects of his condition, you can help improve his quality of life. Encouraging healthy habits, providing emotional support, and seeking professional help when necessary are crucial steps in managing his anxiety and constipation effectively.

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