Apologizing in advance for this topic and the level of detail!
Mom has struggled with constipation for many years. She has managed with Ducolax and a enema bottle device to add water to her dry anus. 1 week ago she fell and broke her leg and is now in skilled nursing. She cannot put any weight on the broken leg and is too weak to support and pivot transfer into the wheel chair to go to the toilet.
Sitting on the toilet is preferred to defecating in her diaper for cleanliness reasons (she has an open bed sore dime size) but also for physical therapy reasons. The more she gets up and moves around the sooner she will be strong enough to go home after her leg heals. She wants to do her routine so she can defecate quickly but cannot do so with her broken leg.
But to get her to the toilet takes 3 people - 2 people to transfer her and one to hold her broken leg off the ground. Very difficult to arrange more than once a day for the staff.
So the first time her nurse did the digital stimulation and then the second time she asked me to do that. I am very grossed out by that especially when she asked me to do it multiple times.
She has been able to defecate a couple of times without stimulation but only a small amount came out and she did not feel relieved. She doesn't want to drink a lot of water because it goes right through her and she would need very frequent diaper changes. She IS drinking water and liquids and is not dehydrated.
Only nurses can do this, no CNAs, right? What can be done to allow her to do this herself? She has to use the potty chair for support which is positioned over the toilet.
My mom's bowel troubles were one of my major stressors, it wasn't uncommon for her to go more than 7 days without any movement. You will get a hundred different recommendations from a hundred different people but for us dulcolax was useless, I had better luck with daily miralax. Bisacodyl suppositories were my dynamite solution to force a movement, they are much easier than an enema. When mom was in the NH they prescribed lactulose.
Thats what they are being paid big bucks for.
My problem is with hospitals and rehabs...they think someone should go everyday. Which my Mom didn't. They would use stool softeners, laxatives and in the end Phillips Milk of magnesia did the trick.
Matter of fact, I am not sure that digital manipulation is even done much anymore b/o the vaso-vagal response. It’s frightening what can happen- it happened once to me as a relatively new nurse and scared the crap (no pun intended) out of me. I remember this so clearly as yesterday. The patient was a big guy, I was a strapping 22 y/o 120# newbie. I learned a lesson that day.
And if my memory is correct, it was never done with someone sitting on a toilet. It was done when the person was in bed in a semi Fowler’s position. It’s too dangerous as someone can pass out right there in that tiny hospital bathroom.
I wouldn’t want a CNA doing it. No way.
If she doesn't get this, its going to be a constant battle every step of the way and a constant brow beating for not taking her home. She needs to be able to be strong enough to do this herself but will they let her?
I think your mother has an obsession and you are joining her reality, all you have to do is to read through this forum to hear about people who feel compelled to use the toilet or feel they are constipated even though they aren't. IMO digital stimulation should be the very last option when every other change of diet, laxative or enema has failed. I too was obsessed with my mom's bowel movements (or lack of them) and was certain that they would be the death of her, I was terribly anxious that she would become impacted once she was in the nursing home. She didn't, in fact it was never really a concern for her there. Who knew.