Can dementia disrupt your bowels?

I finally was able to take my mom to see her doctor. We almost didn't go because she was giving me the excuse that she didn't have the energy and the will power to go out. So I asked her if she would like to wait and suffer for another one or two months for the next appointment or she can just power through for a couple of hours and find out how to resolve her bowel issues. She argued for a bit and then agreed to go with me. Luckily, she has a really nice and thoughtful doctor. I told him what happened for the last couple of weeks. He checked her rectum and decided that she didn't have fecal impact or any blood. He did not insist on her continuing taking the Miralax but suggested that Dulcolax suppositories might help. Lo and behold, as soon as we went back and tried the suppositories, all the stool that she has been trying to void all day has now come out. For the next hour or two, mom has not gone to the bathroom. I thought that was it until two hours later, she said she has to go move her bowels. I was so relieved before and now my relief has disappeared. For the next two hours, she kept going to the bathroom, saying she felt something was inside ready to come out. But there was nothing she could evacuate. I think her brain has been wrongly trained to tell her to go even though there is nothing. We'll see if this continues if though we now have a way to empty out the rectum,

JIGSAW- the Nurses and Nurse practitioners are with Hospice and with her Primary Dr who is a geriatrician who comes to the house. No facility- and I hear ya on the 20 times a day thing, as in its ONLY 20 times now. I almost laughed- its almost funny except when you are doing the back and forth thing ALLLLLLL day. Its nice (in a weird way) to know Im not the only one doing this. Some days I think a facility would be a treat, but we are at the tail end of things and I am trying my darndest to make it through with her to the end.

I was reading Susiemen's through explanation of what may be happening and it reminded me for everyone, constipated or not, problems going at all or not, a stool or something to put their feet on (and yours) can be very helpful. Growing up we always had a stool in the bathroom, so did my great grandmother and my grandmother in every bathroom of their houses, I always thought it was because we (the women in the family anyway) had short legs and maybe that's true but besides giving your feet something to touch it put's your body in a better position for voiding and helps your bowels do their job without as much strain. Think about it or try it, the position also shortens the amount of area the stool has to travel, gives a straight shot to the toilet bowel below and gives you better leverage for bearing down if need be. Yes I gave seen the Squatty Potty, brilliant the way it tucks in against the toilet but the basic idea has lived in our family well before I came along so long before Squatty Potty was ever thought of. I have thought about getting one but to tell the truth the stools come in handy for other things as well and I have 2 that came from my GG so they hold sentimental value too.

Jigsaw: That is a fine balancing act. My late mother had the same problem--too much Miralax and then she was afraid and would never take it again!

Thank you all for your input, advice, and comments. I really appreciate it. So, a couple of days ago, she had diarrhea, all night long. She must have taken a little too much Miralax. The constant explosion was just unbearable. I would think that fecal impact might not be what she was having. Now, she is not as obsessed as before. In fact, whenever she feels the need to go, there would be some stool for her to extract. The signal to the brain seems to be reversed, where soft stool would leak out without her knowledge and it would be 5 or 10 minutes later that she realizes she has to go and then she would see the leakage on her panties. I am reluctant to give her laxatives or stool softener as she seems to be moving her bowels now, just a little delayed. I am taking her to see her doctor later this week and we'll see what the doctor has to say. Thank you all again for your responses.

JigSaw- my mother is 88. I could have written your post. It has gotten so bad that night times are just as bad as day with this back and forth to the toilet. even on a sleeping pill. I wonder if it is part mental /dementia as in maybe a fear of there is more that needs to come out etc. as well as the sensation of having to go-
Only things helping me currently:
A. Knowing what causes loose stools for her - such as those greasy Ensure supplements- then I give her one when she is having a particular difficult day
and B.) a daily stool softener to make it easier to pass
I tend to get upset with this whole using the hand and fingers business because of the UTI problems it causes

Yes, absolutely! The patient's mind is broken and therefore not sending the signal to the brain that "it's time to go to the toilet for #2."

Mpost definitely! That UTI will never go away at her age due to her hygiene. What is she eating?
I never say my Mother eat chocolate like she does now. She hoards it when possible. She may be eating things that she could be hoarding.
Talk to her doctor about what she's doing to get her bowel to empty....not a good thing, she could damage herself as well as she most likely is not washing her hands well!!

Please have a doctor examine her for a fecal impact, as it sounds as if she may have this. It often occurs after one has been severely constipated for more than 2 days. A fecal impact is when a hard, dry mass of stool becomes stuck in the colon, and the person is unable to pass it or extract it on their own. They often must resort to manually extracting the mass of stool (that is, removing the stool with their fingers). This does not tend to solve the problem, however, as the entire mass of stool can not be extracted manually by hand.

The person has to ingest heavy, greasy foods to help the stool absorb grease and moisture, and to extracted from the body more naturally. Greasy Chinese chow mein or Chinese food (not Chinese fried rice) often helps quite a great deal, as does soda, such as Sprite or Pepsi (for some reason). Contrary to what one may think, drinking a lot of water, eating fruits and vegetables, or eating beans will not help a fecal impact. The body needs heavy grease and soda to help extract this stool, not natural solutions.

My husband has fronto-temporal dementia and can no longer tell whether he truly needs to urinate or not.

My mom had the problem, and I am experiencing the problem too. I take Smooth Move Tea and the problem goes away. Drinking more water helps and just walking more. But the tea really helps.

Many elderly females have problems of rectocele/ureterocele due to previous weakening of the pelvic floor from vaginal childbirths. This worsens with age, and can result in filling of the rectocele with stool, which hardens and is almost impossible to pass except for digital extraction. This constant chronic forward pressure can cause vaginal prolapse, as well as incomplete emptying of the bladder when voiding. This can lead to urinary tract infections from ascending germs from the perineal area not being washed out completely with each void. The feeling of persistent need to defecate is due to the downward pressure on the anal sphincter of retained stool, which is usually too wide to come through on its own without development of rectal fissures or hemorrhoids. Trying to increase water consumption is very important--or increased fluid intake of any sort that is primarily water-based (juices, coffee, tea, broth, etc.) the more the better (except for when heart failure or kidney failure are problems). Sometimes giving a couple of tablespoons of mineral oil will slicken the stool making it less able to be retained and packed into an impassable glob. This must be done daily (for safety, divide the dose) until the stool diameter is decreased enough to slide on out. It must, however, be given very cautiously, as could create aspiration of oil into lungs if choking occurs. The best way is to mix it with, e.g., ice cream, which already has an oily base. If giving mineral oil regularly, replacement vitamins which are fat-based (e.g. D, A) should be given as a supplement to avoid deficiency. Also, feeding stewed prunes or prune juice also helps. The one problem with rectoceles is that once there they remain unless the patient is able to perform routine Kegel maneuvers to strengthen the pelvic floor (or have surgical correction if severe), which a dementia patient would not understand. Any fiber additives to the diet must be done cautiously, as when they are not accompanied with a major increase in water liquids, can cause a significant worsening and even obstruction. The dementia can cause incontinence problems of both urine and stool as it progresses, but it sounds more like this case is based on what is above described.

I give my husband Miralax three times a week and a suppository every other day.

jigsaw, I understand your question isn't about constipation. One incident had my Dad on the toilet for hours, and the question was like yours? Does he even need to go? He was so embarrassed and uncomfortable. I think eventually he was probably "talked down" and given an enema or laxative. I was visiting from out of state so the timing was so bad I could not stay long enough. I hear ya.

It’s common for the elderly people who get constipation due to medications, not drinking enough water and/or back problem. Try giving her a warm glass of apple juice or prune juice. Her doctor may have to pull her stool out of her butt if it is compact.

Directly or indirectly dementia often causes bowel issues, constipation being the most common I think. Sometimes it's medication related, often I think dehydration or just the tendency to not get enough fluids throughout the day plays a big part, diet and lack of exercise or simply no getting out of bed much play a part and of course simply the mind playing tricks, forgetting they just went or causing the nerve/communication between body and mind, sometimes all of the above. Oh and then there is waiting because they don't feel like getting up so often it backs them up, vicious cycle. Whatever the cause it's probably important you take her to her primary to make sure she isn't impacted and figure out if medication might be playing a part. This also offers you a chance to reset if you will and hopefully get her away from the assistance habit.

Depending on her doctor they may want to prescribe stuff right off the bat, I would encourage you to try other basics first, altering body functions with medication takes the control and normal measure away so you can end up throwing multi meds at various side affects and that vicious cycle. My mom went through this and can still have the tendency to bind up if she doesn't stick to the program. Fiber (Metamucil or any psyllium husk based supplement), making sure she was getting water and then moving around each day took care of it. I got her the no-sugar (she's diabetic) orange flavored fiber because it forces her to have a glass of water at the same time and she loved the flavor, thought of it as a treat (not sure I would go that far) though she has now moved to pills (not my choice). But if you can add enough fiber with just diet that works too, someone mentioned a prune every day (better than taking a laxative IMHO if it works and a laxative is needed also) and then reminding them to walk each day to prevent the constipation. Even with memory issues the experience of being so constipated is memorable. The tendency toward obsessive behavior is a good point too and I hadn't considered it but it makes total sense to me anyway that this can be a factor with some dementia patients another reason to try and make a doctors appointment a redirecting reboot if you can.

Someone mentioned a toilet full of bright red blood, this is very common when someone is straining to pass stool even without hemorrhoids, though too much of this can cause them, it's just some of those blood vessels close to the surface bursting from the pressure or stool passing while they are enlarged. The rectum/bowels have a large number of superficial blood vessels and while it often looks like a lot of blood it isn't and it's not like a cut that you need to put pressure on to stop bleeding or anything. Bright red blood is fine, it's when you see darker blood or dark stool with a foul odor (more foul than typical) that you need to take notice and call a doctor. Internal bleeding will cause the darker blood and the dark foul stool (looks like coffee grounds) could be blood in the stool. Now there are other things like iron supplements I think that can cause dark stool too which is why a call to the doctor is in order. Sorry I know that got off your topic a bit jigsaw.

Perhaps just incorporating more fruit into the diet would make all the difference. If she would eat a peach or some cherries each day, this may have the desired result.

When I first saw the title of the question, I thought this might be addressing bowel conditions in the caregiver as a result of the stress of care giving for a person having dementia--I'm sure there are many caregivers out there who can speak on this from experience!

Liquid fleet, perhaps? Not without talking to doctor first.

She probably "feels the need" but then is unable to void and the dementia is preventing her from explaining it to you.

This is a BIGGIE! This does need to be addressed before she becomes impacted.

Have you tried Stool Softeners? I was told to use the one without the laxitive - it is only a stool softener. You might also need to use Milk of Magnesia - but NOT full strength or you could wind up dealing with diarrhea which is not a picnic for either of you. Never try MOM's more than half-strength which is 2 TBL. In fact, start with only 1 TBL. Going from experience, when it goes - it goes! No time to reach the bathroom. So start small - you can always give another Tablespoon later.

If neither of these work, call her physician immediately since this has already been several days.

If I misunderstood your question - I apologize. But my DH had trouble in this area and I had to learn as I went.

Hugs to you and good luck,
linda

My mom is 86 and has similar problems. I use the V8 fusion juices daily to help regulate her. On occasion I will also need to use 30ml-60ml of milk of magnesia as needed as well. Hope this will help you!

jigsaw my mother (96) also uses digital assistance as a result of decades of recurring constipation. Since I have been helping her with personal care, I have a constant supply of vinyl gloves and a small metal lidded container right by the toilet for her to use. And she has been using it every time she moves her bowels. I keep her nails trimmed to avoid the glove tearing. I make sure she has a prune every morning with her pills and water and I put benefiber in her ice tea. Twice, before the regiment, I witnessed (before she flushed) a bright red, blood filled toilet bowl. First time, it freaked me out and I took her to emergency which ended up in physical examination of her rectum as well as scans, an overnight stay for observation, follow up with digestive disease specialist and the conclusion that it was: hemmroids. That’s it. And, a $18, 000, Medicare and Humana paid bill. After a brief examination, the gastroenterologist scolded her about the DA. That for a $45.00 copay and the admonishment of “changing her diet”.

I think of the brain as the hard drive that controls the rest of the body. When the hard drive is on the blink or is missing a sector...the rest of the system won't work right.

I agree that this is an obsession. We had a recent post that detailed how a person is trying so hard to evacuate his bowels he’s aggravated his hemorrhoids and is in much pain because of this. It was suggested that he have a scan to determine if his bowels were impacted, but I suspect that in his case, like your mom’s it’s an obsession.

Using an ungloved finger is unsanttary. If she scratches herself with a fingernail, she could wind up with one heck of an infection.

She may may benefit from an anti-anxiety medication. Watching her diet may help as well.

I've read similar questions so it isn't uncommon. I think that what is going on sometimes isn't actual constipation but an obsession that leads to unhealthy behaviours (the digital manipulation or laxative overdoses). I know there have been a couple of people in my mom's nursing home who are constantly asking to be taken to the bathroom even though they had just been there. This has to be one of the more difficult behaviours to manage because she can do herself harm - have you mentioned this obsession to her doctor?