I hope someone has some experience with bowel issues. I apologize in advance for a graphic description. My mom is 92 years old and 90 lbs in a NH. She has dementia but can express herself, usually happy, very rarely cranky or acts out, just her memory is shot. She had major bowel resection surgery 2 years ago due to ruptured diverticulosis. She is not on a bag and can tell the aids when she has to use the potty. She is now on 100 mg tramadol at night (up from 50mg) and 50 mg in morning for arthritis. She’s not really what I’d call “constipated” as she does have a BM daily or 2nd day, but they are immense. Scary immense. The aides describe them like softballs, the Lpn call one a football. (Good grief, I never thought I’d be having this conversation.) Needless to say they are very painful. Today when I was there with 2 aides she was on the toilet screaming, and still didn’t “go”. She sometimes experiences vasovagal syncope, almost faints on the toilet, so today we gave up and let her lay down and gave her some apricot juice. Obviously I don’t want her in pain. I don’t know if these bowel habits are the result of missing some of her bowel, or maybe the tramadol? Opioid induced constipation like I see on TV? She has been on Miralax 2X a day and Senna once a day, but they may not be doing the “job”, and I’ve read that senna shouldn’t be used long term. We’ve started offering her prune juice at meals but she hates the taste and won’t drink it. Maybe I should request apricot juice routinely instead.
Does anyone have any suggestions for a better way to address this issue in a teeny old frail lady? Thanks.
Stool softeners are just that...they keep more water in the large intestine UNTIL you pass a BM. It is not a laxative that forces the bowels to contract and therefore move the stool out.
Always drink enough fluids /water.
Since constipation isn’t the issue - is it the volume? The consistency? Shape?
I have to mention that the timing and consistency of my mom's bowel movements was a constant source of worry for me and a huge stressor while she was in my care but now that she is in the nursing home they just let nature take it's course and she is rarely ordered a laxative (and this is a woman who was previously on every laxative ever manufactured in order to have a BM once a week!). She is still with us over a year later and doesn't seem to be any the worse for the lack of constant vigilance... who knew?
For years (40 that I know of) applesauce (apples contain pectin) was used to combat diarrhea by increasing the viscosity and volume of the stool.
IF you find that the apple juice isn't "doing it", that may be why. Below is a list of 10 good foods (mostly for fiber) to help with constipation (according to healthprep.com);
Coconut water (fluid and potassium), all berries, figs, yogurt (good for intestinal bacteria), artichokes, legumes (beans, green peas, chick peas), sweet potatoes, broccoli and flax seeds (lines the intestines with a coating).
Drink plenty of fluids so the body doesn't have to pull the water out of the stool. Hard to get elders to drink, however. Offer sips every hour.
Hope this helps.
Also increase fiber (it's in a lot of things you wouldn't expect like blueberries and raspberries), increase non-salty fluids, get more exercise (if possible), more fresh fruit, often a hot cup of coffee will get you going. Will she eat baked goods with prunes in them (prune danish, prune-zucchini bread, etc.?
I hope you get somewhere with this soon!
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