Elimination Matters for Eating Well, Too: Constipation and Esophageal Disease Can Affect Appetite
Written by: 増田 翼 (Registered Nurse)
Food that we swallow passes through the esophagus and reaches the stomach in about 10 seconds.
The esophagus is like a single tube wrapped in muscle. The movement of this muscle carries food down to the stomach.
Once food reaches the stomach, it is digested by stomach acid, then absorbed in the intestines, and what remains leaves the body as stool. We have all experienced it: when we can’t pass stool, the belly feels bloated and we lose our appetite.
In this column, I’ll talk about support for what happens after swallowing.
Case 1: D, who began eating less because of constipation
D, whom I visit as a home-visit nurse, has dementia with Lewy bodies and had become unable to speak or move independently.
Because D’s swallowing function had also declined, D was eating texture-modified care food. When D’s wife told us that D had been eating less lately, we were allowed to observe a meal. D ate the care food without coughing, and there seemed to be no particular problem with eating itself.
However, D’s belly was distended, and when I listened to the bowel sounds, the intestines seemed sluggish. When I asked D’s wife when D had last had a bowel movement, it turned out that it had been more than a week.
So, suspecting that constipation was why D couldn’t eat, I helped D with bowel movements. D’s appetite returned, and D was able to eat as before.
Loss of appetite may be a problem of elimination
When loss of appetite or weight loss continues, people tend to suspect that swallowing function has declined. But a similar situation can also be caused by food not moving well after it has been eaten.
Constipation has many causes, but people with dementia with Lewy bodies are particularly prone to sluggish digestive movement and constipation. Bedridden people can also become constipated as the movement of the intestines (peristalsis) slows.
Dietary tips for regular bowel movements
To keep food moving well, it is important to keep bowel movements regular. A balanced diet is the foundation, and getting dietary fiber and lactic acid bacteria improves bowel function and helps prevent constipation.
Dietary fiber: Abundant in vegetables, mushrooms and seaweed.
Lactic acid bacteria: Easy to get from yogurt and similar foods. It is better eaten as a dessert after a meal than as a snack between meals, because on an empty stomach, stomach acid is more likely to kill the beneficial bacteria.
Case 2: E, who lost 8 kg because meals were hard to eat
However, be aware that problems other than bowel movements may be hiding behind loss of appetite.
E said, “Lately, meals have been hard to eat,” had no appetite, and lost as much as 8 kg (about 18 lb). E had long-standing high blood pressure but had never had an illness that would weaken swallowing function.
E’s nurse, who was worried, asked me, “E’s swallowing function seems to have declined; could you give us some advice?” When I talked with E, there was no problem chewing food, and E didn’t seem to cough while eating. However, E had a feeling of food getting stuck around the throat, and that seemed to be what was making it hard to eat.
The stuck feeling was caused by esophageal disease
The cause I suspected was a disease of the esophagus. With diseases that narrow the esophagus or impair its movement, food may not be carried to the stomach properly even after it has been swallowed.
I suggested that E have a detailed examination at a hospital, and the tests did indeed find a tumor in the esophagus, which was causing the feeling of food getting stuck.
How to eat when the esophagus has narrowed
To help food pass more easily through the narrowed esophagus, I suggested taking smaller bites and chewing well. In this way, E was able to eat even a favorite food: ramen.
However, keeping bites small and chewing well increases the number of chews and swallows, so eating itself can become tiring, and the person may not get enough nutrition. So I also suggested a nutritional supplement so that E could get enough nutrition even from small amounts.
Watch out for aspiration caused by reflux
When there is a tumor such as cancer in the digestive tract, the passage food travels through, the flow can back up, food can come back up into the mouth, and it may be aspirated. And when food that has already entered the stomach comes back up, it contains stomach acid, so it can badly damage the lungs and tends to cause severe illness. Care is needed.
Here are some ways to prevent reflux:
Choose clothes that don’t put pressure on the abdomen
After meals, avoid movements that involve straining the abdomen
If the person eats with the bed reclined, keep the head of the bed raised for about 30 minutes after the meal
Keeping the head of the bed slightly raised during sleep can also prevent gastroesophageal reflux at night
Chewing food well not only helps it pass through the throat more easily but also stimulates intestinal movement, which helps keep bowel movements regular. Make a habit of chewing well at every meal.
Interest in eating function as a way to prevent aspiration has grown in recent years, and elimination is just as important. Esophageal diseases are also said to be more common in people who drink a lot of alcohol, people with obesity and people who smoke. I hope you will review your lifestyle habits too, so that you can enjoy meals at any age.
About the author: 増田 翼 (Registered Nurse)
This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.
This is an English translation of a column originally published in Japanese by Next Co., Ltd.
About Next Co., Ltd. We are a Tokyo-based company working in Japan’s senior care and end-of-life planning field. Alongside these expert columns, we publish professional training textbooks and support businesses entering Japan’s eldercare market. More expert columns | Our English textbook | Contact us
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