Mom's bowel problems... again! What to do?

shamboMay 29, 2006

Last August I wrote about dealing with my mother's constipation problems. Two days ago she told me that, once again, she "thinks" she hasn't had a bowel movement for about two weeks. My mother is 91 year old and lives in an assisted living facility. It's becoming harder & harder to get any sort of concrete information from her, so I never really know what to believe. And she told me that she's been lying to the aides when they ask her about her regularity.

Last year taking care of her impacted bowlels was a two day process: The first day included a doctor appoinment & exam, followed by an x-ray. The next day included a trip to the hospital ER for another x-ray, a Fleet enema, manual extraction, & a gallon of that special stuff given to patients before colonoscopy.

Since August she has been taking the following: Four 50 mg Colace daily; four Metamucil capsules daily; one Ducolax laxative Tuesday & Thursday; Two tablespoons Milk of Magnesia Monday & Friday. She drinks about 1/4 to 1/2 cup of fluid at each meal. In between meals she takes in just enough water to get her medications down. I've tried all kinds of things to get her to drink more fluids, but nothing seems to work.

I'm frustrated and don't know what to do. I see her regularly and don't understand why she waited until a Saturday night to tell me. I've been sick myself this weekend and can't do anything to help her. She doesn't want me to tell the staff at her assited living facility what's going on. I really don't want to do the ER thing again. The staff there was upset that my mother's doctor didn't have his staff perform the manual extraction. Plus I'm not physically up for a two day adventure this coming week.

Any advice?

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Oh, dear!!! there's not much that you will be able to do. It's going to have to be something that a medical staff will have to take care of again.

Do you suppose that there might be a chance that she had a BM and just forgot that it happened? She may need more oversight than an assisted living facility is trained to give. It might be time to start thinking about a regular NH. They would be able to see that she got proper results from medications. She may need stronger laxitives.

    Bookmark   May 29, 2006 at 9:24PM
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You're talking about really unpleasant solutions for all concerned plus VERY dangerous complications if ignored. The monetary, emotional, and inconvenience costs are substantial as well. IMHO, this is just nonsense -- an unjustifiable waste of medical resources as well as your own. If I was in charge of the facility where she's living, you would already have received notice.

Your mother is being unreasonable to the point of (most likely) incompetence. Clearly more control is needed. Her "assisted living" situation may have to be abandoned. The "assistance" that's needed in her case is considerably beyond what such a facility should be required to give, based on your description.

    Bookmark   May 29, 2006 at 10:32PM
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That's a lot of "stuff"for constipation...I would try a couple of things. If she is eating, not vomiting, having abdominal discomfort or distention, I would bet that she is having more BMS than she thinks.....
Does she go to the bathroom unassisted? If not, put a notepad on the wall in the BR and have the aides note the date of a BM.When i care3d for my mother at home, even tho she was completely unable to know when she had BMS, I had to mark them on a calendar so I would remember. When you are busy, it is hard to remember such as that.
Is she getting roughage, veggies, fruits. bran in her diet?
What are the tricks she used when what foods "made her 'go'? Try them.
It is hard with elderly. Miralax is very effective and avail over the counter, but hard to deal with in some settings.
Good luck! Derry

    Bookmark   May 30, 2006 at 12:41PM
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This goes right back to the dietary thing already discussed in other threads.

Asolo is right, clearly your mother requires more supervision. And constipation is largely due to poor diet, insufficient water, and insufficient exercise. It's really pretty simply addressed. But someone has to DO it. Insist on it.

I am no fan of extended care facilities. I've seen Mum in several of them on and off, over the years, and her chronic constipation while in them was a "no brainer". Take a good, long, critical look at the meal trays sometime. They're pathetic. My cousin is registered dietician and was told by the adminstration that her suggestions to improve the menu and minimize constipation (it's rampant in NHs) were "unrealistic". I brought her fresh tomatoes from our garden... both she and her room-mate were thrilled. I washed them, sliced them, drizzled them with some light dressing and freshly ground black pepper. They gobbled them up, my next visit found them relieved to have had such a "comfortable" BM... what does that tell you about the crap they were being fed?!

It's easier to dole out the Metamucil and Colase than it is to see that there are adequate servings of nutricious, liquid laden fruits and vegetables. And it's a lot of work to put a glass of water/decaf. tea/coffee, whatever in front of a patient and monitor it's consumption. But at between $4K and $8K/mo. you have every right to expect that it will be done. You're paying for it... either with saved money or YOUR tax dollars.

If the patient can walk, then they NEED to walk, and someone needs to be sure they do and supervise them if required.

Mum's doctor is a proponent of natural remedies for constipation... when Mum had her most recent bout with it, she ate fragrant, perfectly prepared BROWN rice with sauteed vegetables for dinner. She had 2 glasses of water (no wine) and a tangerine for dessert. She was fine the next morning. But she bellyached for a "laxative"... sorry, "no can do"... ;)

Constipation is easily prevented and "cured". Insist that it be done with diet on a daily basis. Laxatives are a last ditch remedy... ruinous to overall colorectal health, but an easy short-cut for overburdened, inexperienced staff.

    Bookmark   May 31, 2006 at 4:28PM
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Shambo, how is your mother doing??? This is a huge problem for the elderly. Some good advice was given in the above posts. My mother was an invalid for three years. I would bake apples, remove the skins after they were baked (skins enhance the flavor of apple) and give her a nice portion every day. I also made whole wheat buns with bran, wheat germ, and raisins included which she loved dipped in her coffee for breakfast. She didn't like to drink water, either, but would take little sips to please me when I offered it to her. She would drink orange juice and some broth from my homemade soup.

I had to monitor her bowels DAILY and take action if she missed a day. When she missed a day, I would give her baby food plums (not prunes) in addition to the baked apples. They would help her. (The bottle indicates they are mixed with a couple of other fruits.) When she was admitted to Hospice, they gave her a laxative with Senna which I had to resort to at times. Also, I would have to use a lttle fleet enema or a dulcolax suppository if she missed more than a couple of days. If the assisted living can't stay on top of this, you will have to find a way to do it yourself... It isn't an easy situation for you or her...

Some added thoughts: The metamucil capsules may not be advisable due to lack of fluid intake. Colace never did a thing for my mother when she was in the hospital. Also, my friend tried using colace with her husband and gave up after a couple of weeks.

    Bookmark   June 2, 2006 at 11:04AM
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Thank you for your replies and please forgive me for not responding sooner. As stated before, I was ill last weekend and didn't start feeling better until about Wednesday... just in time for my husband to spend two days in the ER/hospital with chest pains. Finally, we're all OK (for now).

All your suggestions were right on the money. She lives in a lovely assisted living facility. The aides are more than willing to do anything I ask of them. The biggest problem is that my mother refuses to avail herself of their help. Even today, she called me to tell me that two days ago no one came by to give her the evening eye drops. She said she waited two hours. My first question was, "Did you press your call button?" Of course, her answer was, "No." Then for the hundredth time (literally) I told her whenever she needs anything, to press her button.

She may, indeed, need more oversight at this time than the assisted living facility can give. However, she prides herself on her independecne and really enjoys many of the activities. I'd hate for her to go someplace where she'd be less active & social.

Anyhow, last weekend I suggested she try to find an enema somewhere in her bathroom. Lo and behold, she discovered a Fleet enema that I had purchased for her. She used it and excitedly called me the next morning after experiencing relief. I, again, reminded her that she needed to note her bowel movements on her calander so she could keep track of them. I also told her to buy some more Fleet enemas when she went to her next grocery store outing.

All your diet advice is right on the money too. My mom has developed almost a pride in complaining non-stop about the food served at her place. She says it's tasteless, no garlic or onion, over cooked vegetables, etc. So I've bought her flavored olive oils and spice blends to take to the dining room with her. But she refuses to take them or use them. She practically brags about how little of their food she eats. She gets two entree choices at meals and an alternative menu of sandwiches, fruit or green salads if the regular meals aren't appealing. But she refuses to ask for the alternatives. At the same time, she doesn't take advantage of the twice weekly grocery store trips. She could buy all kinds of tasty and healthful things to eat, but she mainly just gets snack type foods. It's all very frustrating.

Thanks, again, for your input, and I appreciate your advice.

    Bookmark   June 2, 2006 at 7:46PM
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Just another suggestion. Can you ask her Dr. or the facility if she can take Miralax. It is mixed in water. My mom was on that stuff for a very long time after she had to have surgery for severe bladder prolapse & hyterectomy. They wanted to keep her regular and keep the stool soft so that there would be no tearing of the tissues that they just repaired. I know how hard it is to keep track of someone else's BM's especially if they can't tell you themselves, as in my Mom's case.

Also, when my Dad got constipated with some of the chemo drugs, he would take it and it helped him out tremendously.

Best of Luck, katclaws

    Bookmark   June 4, 2006 at 5:08PM
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I'm really, very surprised that most who have replied to this thread are, totally, unaware that most elderly folks will NOT, in fact, ask for what they need. And i do think a bit of understanding and a lot less condemnation is called for. Yes, I do know that taking care of a loved one, long term, can be frustrating....but, I truly believe that whatever YOU think you are going through is always much, much harder on your loved one. Never, ever forget that. As to bit**ing about loved ones doing certain things based, solely, on trying to maintain a controlling posture? Geez! What else do they have left?
BM's... I can't think of anything more personal than that...please, please... try and be more understanding of the indignities involved...No, not your, percieved, indignities.. your loved ones REAL indignities.
Regarding medication orders...for instance.. most orders are PRN.... PRN means as needed...older patients are loathe to ask for help...even if they do need pain relief...they, wrongly, assume that IF they really do need it (even if they have told the Dr. they are in pain) then the Dr. would have ordered it.
The problems start when the patient expects to get pain meds because the Dr. did subscribe them (they know this because the Doc has told them he has ordered pain meds...he might, even, say to the patient "don't worry you will have meds whenever you need them)......but, PRN... as needed... the dr.'s order would state xxx drug, Q4, PRN.
Q4 means every 4 hours... problem is, it's only given every 4 hours if the patient, then, requests it.
And they don't....they assume that the nurses will decide if/that they DO need them... they need them...actually, because of the Dr.'s words and orders (misunderstood orders... most patients have no idea what PRN means, or have any knowledge, at all, of medical terminology, let alone, pain med terminology) they will, most likely, NOT get the needed pain relief...nurses, nor Dr.'s, ever explain this to the patients. And, on and on, it orders, meds...constipation can also be caused from meds.
Lastly, I hate to see posts that draw the line, somewhere, anywhere ... of what the caregiver is willing to put up with...Mothers do not draw the line.. they do everything... including cleaning up s**t.... often, for many, many never ceases to amaze me that 1 mother can take care of 2-4-5-6 and even 10 kids all by herself, and yet, those same 2-4-5-6 and even 10 kids can't take care of 1 mother. Yes, I am aware that, sadly, in lots of situations, care is left to one or two kids out of that 5-6 or 10....shame on the slackers...and kuddos to the kids that do take care..
But, do it anyway, even if you have no's the right thing to do..
I'd give my life..really, to have my Mom back to take care of.


    Bookmark   June 5, 2006 at 9:51PM
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Silly, I am more than aware of the fact that PRN instructions are pretty much meaningless. Waiting for an elderly patient to ask for pain relief medication or any other medication is an exercise in futility. That's why I asked my mother's doctors to specifically schedule her medications -- everything from pain meds, to vitamins, to laxative type products. The staff at her assited living facility administers all her medications now so I know for sure she is taking what she needs on a regular schedule.

A lot of my frustration is due to trying to walk the thin line between fostering my mother's remaining independence or taking complete control of every aspect of her life. She lives in a lovely safe and caring community. She has her own one bedroom apartment with a kitchenette complete with sink, microwave, & full-sized fridge. She has many in-house activities daily and several outings each month. The thought of her needing more supervision, possibly in another facility is not at all appealing.

For what it's worth, I am an only child and my father died several years ago. So I am responsible for my mother's care and am trying to do my best. Sadly, there are several residents at my mother's assited living facility that don't get many visits from their families.

    Bookmark   June 5, 2006 at 11:12PM
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Shambo, I don't think that Silly and others quite understand that you want to do what's best NOW, knowing full well that you may have to make other arrangements next month. There may be hard decisions to make in the future. The concept of assisted living is best when it a well managed place such as your mother's. Let's hope that she can stay there a long time. It's good that they are administering her medications. That should help.

Being around others her own age is more mentally stimulating. They can talk and understand the same things. Organized activities will help keep her active. Even those things that she claims don't interest her, will stimulate her in that she will have to think about them.

Sometimes it's easy for others to forget that some caregivers don't have other family members to fall back on for support. I think it makes the strain worse. There's also the problem that men have with their mothers. Sure, they have a responsibility, but they also have a big responsibility to their wives and HER parents. They have to make choices too. Most would say that they have an even bigger responsibility to their wives and children. And their mothers would probably be the first to tell them that.

The saddest thing that I ever saw was a woman that was in the nursing home with my mother and step-father. She was nearly 100 and quite frail. She had only one son still around. He was confined in the same NH and in worse shape than she was. I think he died first and left her with no one. So many people now, find jobs away from the home town and that leaves many of the elderly with no close relatives in the same area. Not everyone can afford to go visit Mother often. The very old ones have usually outlived their friends. All they have are the staff and other residents. So while we see those that don't get visits, etc, it isn't always because the family doesn't care. There may just be no other family.

Take care of yourself, I know that you will find a way to do what's BEST for her and you both.

    Bookmark   June 6, 2006 at 8:32AM
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