bowel in older adults

Overview

Bowel health refers to how well your digestive system (the gut) works to digest food and pass waste. As we age, the muscles in the digestive tract can slow down, and you may notice changes such as constipation, loose stools, or a feeling of not emptying fully. These changes are common but should not be dismissed as a normal part of ageing that you have to 'put up with' — many can be improved with simple measures and medical support.

Yes. Digestive changes are more common in later life. About 1 in 4 older adults experiences constipation regularly, and many notice changes to their bowel habits. This doesn't mean it is 'normal' to suffer — help is available.

Bowel issues can affect anyone, but they are more common in people over 65. People who take multiple medications, are less physically active, or drink too little fluid are at higher risk.

Symptoms

Common symptoms

• Constipation — passing stool less often, or having hard, dry, or painful stools
• Straining to open your bowels
• A feeling that you have not fully emptied after a bowel movement
• Loose or frequent stools (diarrhoea)
• Bloating, abdominal pain, or cramps
• Wind or excessive gas
• Changes in stool colour or consistency

Symptoms in children

• This article is about older adults, but for completeness: children can also experience bowel issues, but they have different causes (such as food intolerances, infections, or anatomical problems) and should always be seen by a paediatrician or family doctor.

Symptoms in older adults

• Fecal incontinence — leaking stool or difficulty controlling bowel movements
• More frequent constipation or harder stools
• Increased need to strain, which can lead to conditions like hemorrhoids
• A weaker feeling of needing to go, or a weaker pelvic floor
• Changes in stool frequency or consistency that last more than a few weeks
• Painful bowel movements

Causes

Main causes

• A slower digestive system, which moves food through the intestine more slowly
• Weakening of the muscles in the pelvic floor, which support the bowel
• The effect of some medications (e.g., painkillers, blood pressure tablets, iron supplements)
• Not drinking enough fluid or eating enough fibre
• Being less physically active
• Conditions such as diverticular disease, irritable bowel syndrome (IBS), or a thyroid problem

Risk factors

• Age over 65
• Long periods in bed or a sedentary lifestyle
• Long-term use of certain medicines, especially laxatives used too often or pain medicines
• A diet low in fruit, vegetables, and whole grains
• Not drinking enough water
• Having diabetes, Parkinson's disease, or other neurological conditions

When to see a doctor

See a doctor urgently if:

• Bleeding from your bottom or blood mixed in your stool
• A change in your normal bowel habit that lasts more than 3 weeks
• Unexplained weight loss or extreme tiredness
• Severe abdominal pain or cramping that prevents you from carrying on your day
• Persistent vomiting, or vomiting with a swollen stomach

Book a routine appointment if:

• Constipation that has not improved after two weeks of increasing fluids, fibre, and gentle activity
• Loose stools or diarrhoea that keeps coming back
• Frequent leaking of stool (fecal incontinence), even if it only happens a little
• Pain or a lump around your back passage
• Feeling that you need to see a doctor for any bowel worry, even if you are not sure it is serious

Diagnosis

To find out what is causing your bowel symptoms, a doctor or nurse will ask about your medical history, your medicines, your diet, and exactly what your symptoms are. They will also give you a gentle physical examination, which may include checking your tummy and, sometimes, a digital rectal examination (a doctor briefly inserts a gloved, lubricated finger into your back passage to feel the internal muscles and check for problems).

Tests that may be done

• A stool sample to check for blood, infection, or inflammation
• Blood tests to check for anaemia, thyroid problems, or signs of infection
• A colonoscopy or flexible sigmoidoscopy — a thin, flexible tube with a camera is passed into your back passage to look at the inside of your bowel
• Imaging such as a CT scan or an X-ray if the doctor needs a closer look

What to expect at your appointment

You will be told what each test is for and how to prepare (for example, a clear fluid diet or laxatives to empty your bowel before a colonoscopy). Most tests are quick and cause only mild discomfort. You can always ask questions and have a friend or family member with you if it helps.

Treatment

Treatment for bowel problems in older adults depends on the cause. Many symptoms can be improved with lifestyle changes, such as drinking more water, eating enough fibre, and being more active. Your doctor may also recommend a care plan that includes new toilet habits, such as not straining and giving yourself enough time. If you have a medical condition such as diverticular disease or irritable bowel syndrome, your doctor will explain which treatments are right for you.

Self-care at home

• You can adjust your diet and activity, but first talk to your doctor or nurse.
• Drink 6 to 8 glasses of water per day unless your doctor advised differently.
• Try to include high-fibre foods like oats, wholemeal bread, beans, fruits, and vegetables — but increase fibre gradually to avoid bloating.
• Do not delay going to the toilet when you feel the urge.
• Allow plenty of time for a bowel movement, and try to avoid straining.
• Keep a diary of your symptoms, food, drink, and medicines to see if anything triggers your problems.
• Ask your pharmacist about gentle laxatives or stool softeners if your doctor agrees — but don't use them regularly without medical advice.
• Strengthen your pelvic floor with instructions from your physiotherapist or nurse.

Medical treatments

Your doctor may suggest treatments such as laxatives or other medications to normalise bowel activity. These are chosen based on the cause of your symptoms and how long you have had them. Your doctor will tell you exactly how to take them and for how long. For some people, medicines to reduce muscle spasm or treat an underlying infection are needed. Never take over-the-counter remedies without checking with your doctor or pharmacist first, and never combine medicines on your own.

When is surgery considered?

Surgery is rarely needed for bowel changes in older adults. It may be considered if you have a condition like a bowel blockage, severe diverticulitis (inflamed pouches in the bowel), or some types of colorectal cancer. Your surgeon will explain the risks and benefits, and a specialist team will support you before and after the operation.

Living with this condition

Living with a bowel condition can feel uncomfortable or embarrassing, but you are not alone. Try to keep a routine for meals and toilet visits, even if you feel fine. If you have fecal incontinence, there are products and services that can help you feel confident when you leave the house. Talk to your doctor or nurse — they can put you in touch with a continence advisor.

Lifestyle tips

• Walk or do gentle exercise daily — even 15 minutes helps your bowel move.
• Try to get enough sleep and manage stress, as anxiety can affect the gut.
• Avoid straining on the toilet — put your feet on a small stool so your knees are higher than your hips (the 'Squatty Potty' position) can help.
• Take your medicines as prescribed, but if you think a medicine is causing your symptoms, discuss it with your doctor before stopping.
• If you smoke, ask your practice nurse or pharmacist about support to quit — smoking can worsen many digestive problems.

Diet and exercise

A balanced diet is one of the best things you can do for your bowel. Aim for at least 5 portions of fruit and vegetables a day, choose wholemeal bread and brown rice, and include beans or lentils. Increase fibre slowly to avoid bloating. Drink enough fluid — at least 1.5 to 2 litres a day — unless you have heart or kidney problems and your doctor advises otherwise. Light exercise, such as walking, swimming, or chair-based exercises, stimulates the bowel and helps you maintain a healthy weight. If you have a specific condition like diverticulosis or inflammatory bowel disease, your doctor or dietitian may give you adapted advice.

Mental health and emotional wellbeing

Bowel problems can affect how you feel about yourself and can make you anxious about going out. It is completely normal to feel frustrated, embarrassed, or worried. Try to name the feeling and talk about it. If you feel very low, anxious, or you are avoiding social situations, speak to your doctor — talking therapies can help you cope. You are not putting anyone out by asking for help.

Prevention

You cannot prevent the natural ageing process, but you can reduce your risk of many bowel problems. Eating well, drinking enough, staying active, not putting off going to the toilet, and going for screening when you are invited all make a big difference. You can also prevent constipation by responding to the urge to go and giving yourself time in the morning.

Vaccines

Some infections can cause diarrhoea and vomiting. The flu and COVID-19 vaccines protect you from illnesses that could make you very unwell. Your GP or pharmacist can tell you which vaccines are recommended in your area. A vaccine for shingles is also recommended — it can reduce the risk of painful rashes that sometimes affect the abdomen.

Screening programmes

The NHS in the UK provides a bowel cancer screening test called the Faecal Immunochemical Test (FIT) for everyone aged 60 to 74 every two years. If you are older and have not been screened, ask your GP. Some countries have different screening programs — contact your doctor to find out what is available. Screening can detect problems early, often before symptoms appear.

Complications

If left untreated

• Untreated constipation can lead to fecal impaction (a hard stool blocking the bowel) and severe pain.
• Continual straining can cause or worsen hemorrhoids (piles) or an anal fissure — a tear in the skin around the anus.
• Severe diarrhoea can cause dehydration and low levels of important salts (electrolytes).
• A sudden change in bowel habit can sometimes be the first sign of a serious condition like bowel cancer, so it is important not to dismiss it.

Long-term outlook

With the right support, most bowel problems in older adults can be managed well. Even for more serious conditions, there are many effective treatments, and early detection gives the best chance of staying well. Age is not a reason to accept discomfort — you deserve a healthy, active life.

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