Constipation is bad - help!

My mom used to have chronic constipation but she was unable to tell me because of her Alzheimer's. Since she was so uncomfortable she would wander around which made her high, high risk for falling.   Be careful using Fleet enema or Milk of Magnesia (MOM) if they have kidney disease; phosphate-based laxatives can do more kidney damage (you have to have healthy kidneys to take this), and MOM can cause magnesium toxicity. I do my best to preserve her kidneys because she is not a candidate for dialysis.  Go to your doctor and get lactulose -- which is basically an indigestible sugar and goes to the bowels, collects water and the bowel will loosen. Kidney disease often accompanies constipation. I put a lock on my flush toilet so my mom won't be able to flush and I document on the calendar when she has a bowel movement. They can get impacted as little as three days, but also know the normal pattern of bowel movement. Some people normally go every few days and have done so all their life.  Since my mom has end-stage Alzheimer's with advancing kidney disease I give her lactulose daily, but not 15 ml as directed--only 5 ml daily is all she needs and she goes everyday like clockwork. One large stool a day. It's the best stuff in the world!

Call the hospice nurses! This is an important part of comfort care.

Your mother is in a memory care? This should be their problem to deal with (or the hospice nurse), and they should have the expertise to do it!

I second (third) the fleet enema, I had difficulty administering these until our nurse demonstrated how to do it, so don't let them push the task on to you. Then, only after it has worked!, you can look at her daily laxative variety and dosages.

Swright, call your hospice team about this and don't take your teeth out of their calves until it's sorted. It is *not* acceptable for your mother to have been allowed to reach this point - it is causing her physical discomfort as well as a certain amount of anguish; and given the morphine px the result was entirely predictable. The morphine should have been accompanied by something like lactulose (or whatever) to prevent the problem. If I were you I'd be livid.

But never mind being livid, be polite but also be persistent and unapologetic until someone gets their ass over to the house and, um, gets things moving. Poor mother! :(

My Mom has a history with Constipation and believe me we've tried everything. Lately its been 30cc of Milk of Mag.( no cramps ) and a glycerine suppository the same morning. Sometimes you have to give the Milk of Mag the night before too. Increase fluids and fiber, Stool softeners help too

Just a cautionary note -

I would be very careful about loading your mother up with things like Miralax, coffee, laxative type pills and/or potions.

Why? If there is a significant impact type situation increasing the need to go by stimulating, irritating the bowels - it can put too much pressure on the lower intestine prior to the blockage and cause a tear or even a rupture. Think along the line of what happens when you continue to flush a toilet that is already plugged up... sorry, not a pretty visual or comparison, I know.

The enema suggestions are good - but not too many as at some point that liquid too causes a build-up situation if nothing is coming out - and if the intestines are beginning to shut down nothing will be absorbed by the body - you’ll just have a huge internal puddle causing more pain and discomfort.

Talk to the hospice folk. What do they intend to do to help? This happened to my dad once towards the very end - he wanted to use the toilet but was to weak to apply any “push”. Could that be an issue with your mom? With my dad - since it was weakness over impact the TRAINED nurse was able to help with gloved finger tips and lotion. Kids - do not try this at home!!! If you don’t know what you’re doing you can make things worse- a lot worse.

Anyhoo - if it were me, I think I’d be asking for an X-ray long about now - or an ultrasound. Either should be able to identify if impacted stool is the issue.

I took my aunt (91) to the ER because her aide said her breath smelled like poop. She was not eating, but not losing weight, staying in bed, nausea and her bp was elevated. When I heard about the breath I took her to the ER. They X-rayed her after figuring out she wasnt having a stroke. Her bp was extremely elevated by this time.
She was impacted. They told me to take her home and give her a fleet enema. I called her HH nurse and they came the next morning, gave her the enema and she felt better. Lost several pounds. By afternoon she felt bad again. The next morning she felt really bad. I took her to a second ER. Another X-ray. Still impacted. They recommended miralax and to see a gastro specialist. Said it would take a little time. Turned out it was her thyroid causing the problem. Too much medication onboard. He advised she take miralax everyday. She does. (polyethylene glycol 350 through pharmacy. Ask dr for script)
Along with a probiotic daily with her breakfast. She has not had another problem with her bowels since starting the miralax and getting the thyroid levels corrected. The dr said no stool softener.

I would try the enema first.  If that doesn't work, maybe try glycerin suppositories.  Apply Vaseline first to lubricate.

If those don't work, you may have to take her to the ER so they can manually remove it.

Hugs, I hope your poor mom gets things moving better.  I know it is miserable :(

I know that high doses of magnesium will help with narcotic caused constipation. Give her like 2000mg a day until she has a BM, then back it off 200mg a day until you find the proper mg without having loose stool. Magnesium will help her relax, so I recommend it be given at night with at least 8oz of water. It can cause stomach upset without enough water.

I hope this helps the 1st night, if not by the 2nd night, she has an impaction and should go to the ER.

Vaseline or castor oil will help with pain and clean up :-)

swright2,
I went through this with my Mother too and what worked for us was first I'd give her a mineral oil enema and if that didn't work,I'd give her a saline enema.The doctor prescribed Miralax which I gave her I believe 17 grams a night she'd chug down mixed with a small amount of water every single night and every single morning,first thing I'd put in a suppository,It was a project and it took some time to get Mom working better in that area,but we figured out what would help her and I let Mom have all the time she needed in the bathroom every morning.She also took a small dose of Senna,but the Colace didn't work for her and she took the Senna everynight too.
I think the Vaseline idea is probably a good idea too.
I'm really sorry you are dealing with this.I feel bad for you and your Mother.Hopefully,you'll find your recipe that works for you all too.Take care~

Use more Vaseline, have the nurse repeat the procedure.

She does rock back and forth on the toilet crying that it won't come out. The nurse used some vaseline to help get some out. I just wonder how long she can go without going to the ER or if hospice will even want her to go. It's a scary situation for me.

The lay person's answer:

Apply Vaseline just before she eliminates. Give coffee just before.
Support the surrounding tissue on the painful side with some tissue/gloved hand.
Cwillie had once suggested wiggling back and forth while sitting on the toilet, but I'm not sure if it was advice for urine or a b.m.

Can she do this by herself without hurting herself?  The nurses should be doing this.

Try not to irritate the delicate tissues. Does she have hemorrhoids? Gently clean and pat dry the area. Apply a hemorrhoid preparation to decrease the irritation and pain .

Take 2-4 prunes daily from now on.

The nurses used to be able to manually remove the hard stool, but that is frowned upon now. So I would suggest a FLEETS ENEMA. It is a solution in a pint size bottle. That might give some of the lubrication that your Mom needs. Have the nurse give the Fleets Enema to your Mom while she is lying in bed on her LEFT side. Talk to the nurse at the Memory Care Unit and ask what the facility's policy is for treatment of an fecal (stool) impaction.