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Dad has moderate to severe vascular dementia and has been living at the equivalent of NH at the VA for several months. I visit every month and I am here for 2 weeks. Today, he was having a severe problem with an incompletely expelled, very hard, BM. At home he was used to being reminded to drink copious amounts of water. He does not seem dehydrated, however from personal experience I know that clear water can sometimes help the situation. Here is not allowed clear fluids due to aspiration risk, because he is not always mindful when drinking. Nurse wants to add stool softeners to his medicine regimen "except for when he is loose". These take hours to work, I'm thinking more water might be better, but he is not dehydrated, just want to avoid more medicine especially one with unpredictable timing. I imagine it is quite uncomfortable for everyone should an aging man defecate in his drawers. I am wondering if milk of magnesia which is a mild laxative, would work better. It doesn't seem to be available to the nurses. Yesterday he knew exactly what dose he needed and how often, because apparently he's had this problem before when he was home, and I know they won't try to follow his own medical advice. Seems more water and an occasional gentle laxative might work better than a regimen of stool softeners. He does not appear dehydrated, but my personal experience says drinking water helps, regardless. Not sure he can be trusted or capable to drink water alone in his room. Maybe they could have him drink a full glass of water as part of the morning and evening medicine delivery system. Does anyone know the ins and outs of this issue as it relates to a sort of nursing home? SS vs laxative vs just getting enough water. Also the ins and outs of calling plain old H20 medicine! Thank you.

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Snowcat60, good call, he was "addicted" to Calm when he was at home with access to do a few things on his own. Now everything gets vetted by his doctor and administered by nurses. Grandma1954, I appreciate the reference to manual, noone else will even acknowledge that is one way that works, and to ignore it is what is obscene, yet, you won't find me suggesting it! due to the reactions and possibly the attempt by my Dad might cause him physical problems. My Mom tells me she used to have to do it for her grown kids a few times when illness incapacitated them. More importantly, Grandma1954, for future reference, and this applies to all remedies, especially the unusual ones, how long does this concoction take to kick in? Thanks for all the good support friends!
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There, you headed in the right direction. Good olde h2o will help solve many problems in older folks. Another thing you can use daily is Ionic magnesium citrate. For my Mom I used Natural Calm and had her drink it twice a day and it worked wonders. Plus it's tastes great! You can get it online or check with a natural health food store.
You cant go wrong with magnesium and just about everyone is deficient due our depleted soil today, especially older people. Give it a try. Your Dad will thank you.
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Our regimen daily for my 93 yr old Mom is 1 dose miralax in juice in am, prune, 20 oz gatorade for sodium during day & senna at dinner. This appears to be working along with any fiber I can get down her. Blessings in your work to make life easier for your loved ones
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Talk to his doctor. My mom's said they makes dementia worse
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Take him to his gastroenterologist.
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First, the nurse can suggest but the Dr. has to prescribe unless she is a nurse practitioner. Try the softener first. Hospitals and facilities tend to be too dependent on laxatives. I took my Mom off when Mom came home for a hospital stay. They think people should go every day. Mom does better with Phillips and Miralax was too harsh.
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We had to take my husband to the hospital for severe constipation. He has always been a big water drinker, but Parkinson's slowed down his system. He was in three days to get him emptied out. He is now on Miralax and Senna S. everyday,which keeps him regular. When he gets too loose, I cut down a little. Mostly it stays the same. You don't want him to go through the hospital thing if you can avoid it.
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Urine chart for dehydration...

http://www.sciencehealth24.com/2016/12/what-urine-colour-says-about-your-wellbeing.html?m=1
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My Mom at 93 has been through the various cycles with her bowels & sodium/chlorophyll levels. She was in & out of ER/Hospital with low sodium and/or constipation. Too much water & her sodium dived. She is doing well for the time being & her regiment has become miralax every morning in juice, prune, any fiber we can get in her during the day & senna at night. So far so good for the past 2 months. Best wishes in this tough journey.
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Yes, I've been through this with my mom. She was taking loads of laxatives and nothing was helping. Not enough water was the main issue. The doctor warned us against any powdered fibre supplement as seniors don't drink enought water and it clogs them even more.

I found this website to be invaluable:
https://www.mamanatural.com/great-poop-looks-like/

The best remedy we found is PRUNES (recommended by doctor after hospital emerg visit) All we do now is make sure she drinks enough water, prune juice, and prunes. No laxative's etc.

There is also a similar chart for urine showing the color in relation to dehydration levels.

Good luck.
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Adding more fiber to the diet is a very natural way to avoid constipation. But, often fiber food can raise potassium levels and/or suppress medication absorption so check with the doctor, even though I find that most doctors know little about nutritional values and prefer a medication route to every problem. Especially true for the elderly.
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I would recommend Miralax or Metamucil. I used to give my Grandma one serving of Metamucil a day and it helped her so much.
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I'm lactose intolerant so a good dish of ice cream is my "laxative."
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I recently applied acupressure on my mother, and it worked like a charm!
Of course, water is the great solution to almost everything, so don't back down on water consumption! But I'm pretty sure nursing facilities add stool softeners to all their patients' meds, simply because it virtually avoids any complications for them and their staff. In other words, it makes their job easier.
But before anyone gets "addicted" to needing a stool softener, you might want to look into acupressure. My mother was recently EXTREMELY constipated, due to some muscle relaxers for her back, and I quickly taught her what I had only briefly researched on Google, and she applied it, AND IT WORKED IMMEDIATELY! If you could teach your dad or anyone at the nursing facility to do it, it could be a beautiful thing.
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Daddy was completely bedbound the last 6 months of his life. With help, he could get up to move his bowels once a day (he had grown up believing that the first thing to do in the am is have a good BM) He was taking a LOT of narcotics, for pain, and along with those, good old Docusate, one three times a day. I do not recall him having any problems, and trust me, I would have heard about it. He wasn't drinking enough, I'm sure, and with all his other problems, the last thing anyone needed was for him to get backed up.
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I could probably go on and on about constipation because that is mom's major issue and nothing seems to work for very long. Everyone's body is different and there just is no one solution for all people. A lot of good advice in the prior comments, as always. A very wise group of people on this forum :).
My mom has never been a big drinker of water and it's only gotten worse. I have tried many mixtures of all the ideas mentioned in this thread, all under doctor's advice. Right now, since nothing seems to work on a regular basis, I have had to resort to suppositories every other day. She currently takes 2 Senna every night and 2 doses of Miralax every day and that worked for about 5 days but then back to the suppositories. It's a constant battle. Never thought I would get so excited about someone having a bowl movement :) Also, it can backup pretty quickly, mom ended up at the ER and they had to manually clean her out, that was horrible! And that was after about 6 days of a lot of little tiny poops all day, every day. I couldn't believe it when the ultrasound came back and showed she was blocked from top to bottom. So now the doctor says a bowel movement every other day at least, use the suppositories if necessary. So that is what I do. Good luck, it's an interesting adventure. Take care of yourself.
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SS won't harm but probably won't help. Miralax everyday was prescribed by top Gastro dr for 90 yr old.
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The best thing I have found is a good, natural probiotic (keeps the good bacteria in your stomach, which alot of meds deplete). Also, a good, natural fiber supplement. Hope that helps!
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It sounds like he's not drinking enough water and he's probably very constipated. If this has been going on for a while, he might need a little help with some laxatives as long as it's not impacted inside of him and hardened to the point it won't come out. If it is, he'll likely need medical intervention if it's that bad. Not drinking enough water will definitely do lots of damage and you can't live long without any water. Not drinking enough over a long enough time will start taking it's toll on the body. What he needs to do is to drink lots of water and not necessarily Coldwater if he's constipated. Lukewarm to warm water actually helps to soften your bowels and help them pass more easily. One thing that would also help if he likes hot soup's is to serve him hot soups and other warm beverages to help soften things up, but lastly he definitely needs lots of water. The human body needs about 64 fluid ounces a day but it's often hard to drink that much but it is possible. I knew someone years ago who lived on tea and coffee until she got a kidney infection and had to cut way back and start drinking water. The kidney infection I guess healed up because I never heard no more about it. One thing you really want to remember is not drinking enough water can lead to a multitude of other illnesses and complications. I found that there is a link between drinking plenty of water and rarely ever getting sick with the cold or flu. I haven't had a flu shot since 88 and never really needed one since then. My secret is making sure I stay hydrated and as much as humanly possible, I avoid sick people. When it does hit me which is rare, I always make sure to stay hydrated and eat a proper diet as much as possible. One friend of mine I currently visit also drinks plenty of water, we both like ice water but simply because neither of us get sick and find ice water to be very helpful in keeping internal swelling at bay. If you ever get a UTI, definitely go for the ice water for sure, it shrinks internal swelling. What would help in getting enough water is to start using a 64 ounce water bottle or even a 64 ounce thermos. With there being a wide variety of drink containers on today's market, you're bound to find something you like. I'll give you a clue. Having a transparent 64 ounce water bottle will help you to monitor how much you've drank that day since the body needs 64 ounces each day in order to function at its peak. Drinking enough water mains you not only feel cleaner internally but you're also more energetic
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A friends Mother was in a Memory Unit. I was told she was given clear water instead of thickened liquid. It went down the wrong tube and she ended up with pnemonia. She did not survive the pnemomia. Water is a danger if your LO is on thickened liquids. Stool softeners work well with my Mother. She takes then daily. When she is constipated she gets milk of magnesia or or a clear liquid ____________ (forget the name). That was working. She is just on stool softeners for  the last 2 weeks and no longer needs the milk of magnesia or ____________. She is getting stronger following injuries and illness she incurred at a former Personal Care Facility.  We moved her to Assisted living at a better facility a few months ago.  The overall care is better and so is the food.  We help Mom by keeping fresh fruit in her apartment, she likes cut up oranges,  bananas and raisens.   Mom is walking at least 50 yards with her walker a day. Walking and getting stronger seems to aid her regularity.  She doesn't mind the stool softeners but doesn't like taking other medicines to keep her regular. She feels a lot healthier and happier going on "her own."
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Mil had severe severe bouts of being constipated she had Alzheimer's hard to get her to drink enough fluids and eat right only wanted sweets : (. Old country doc recommended prune juice slider. Which is prune juice with melted spoon of butter worked like a charm every time for her
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There are various causes of constipation, diet changes, definitely medication can cause some constipation. I wouldn't give a daily laxative, but a gentle stool relaxer once in awhile would not hurt. His meds could be causing some constipation. Give a gentle stool softener with bedtime meds, or early morning meds.
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Just add a half of teaspoon or even less of ground Flaxseed in water or juice or sprinkled on food and everything comes out smoothly, without troubling other conditions. Using just a pinch of flaxseed daily also has health benefits: similar to fish oil and then some.
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Miralax is the best.
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Stool softeners are harmless and won't hurt him.

It is not a laxative.
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Well this brings back memories...I had many "poop" talks with the Hospice nurse.
We did a daily stool softener. 2 twice a day. And often that was not enough.
I did prunes daily as well. then when he could no longer eat prunes I heated them with a bit of water to make a puree. (by the way warmed prunes work better than room temp)
I also on occasion made a tea, Smooth Move Tea you can get it at the store it is herbal and contains pretty much the same ingredients that the stool softener does.
I also added Benifiber to cereal or a drink. BUT....when I had to begin using a thickener for liquids the Benifiber had to be discontinued. It thins out the thickened food.
I also resorted to a bottle of Magnesium Citrate once in a while. (I always discussed this with the nurse first)
Then I got a bottle of what I called Heavy Industrial Laxative, Lactulose and he got that 2 times a day.
Once in a while "we" Hospice was involved with this as well we used "The Bomb" ..wait for this..1/4 Cup Milk of Magnesia, 1/4 Cup orange juice and 1/4 Cup Prune juice. All of this gets warmed up a bit. This mixture does work.

As the body declines and the person does less and less all digestion is a bit slower. This is to be expected.
The last thing anyone wants is for the person to become impacted. This may require manual removal if possible (sorry for the visual there folks) or in the worst case surgical intervention. That can be major since Dementia patients do not do well with Hospitals in general nor do they tolerate anesthesia well.

The stool softener that they want to give is the easiest first step. Trust me you will eventually probably resort to at least 2 or more of the methods that I used.
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Dad is 96 and he too was having small hard stools and would strain. The doctor added miralax which is better than a stimulant laxative and also the Colace as a stool softener. It has done the trick. The elderly are notorious for not being hydrated but as mentioned previously, the peristalsis is also an issue. So don't worry about adding these things.
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Forgot to say, the immediate problem seems to be solved. No one wanted to give him an enema, and so thank heavens that's over for now. He had some prune juice with breakfast just to be sure.

He will be taking a low dose of something, maybe the miralax, unless he gets too loose. I'm afraid there's not much point in trying to solve it to the T naturally, he isn't functioning at a high enough level to explore all possibilities. He is on palliative care, just want him not to be uncomfortable. Or embarrassed!
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This is awesome information, all of it. I've forgotten the exact one he's taking, but Miralax was in there somewhere. The advice about the system slowing down is a brilliant new concept for us to remember, and electrolytes have always been an issue, had no idea that was related to the amount of water you drink, maybe that was part of one of his initial problems, he would shake uncontrollably and it was generally helped with electrolytes. Now that he's not getting as much water, it is quite possible that's why I haven't heard of him having (or seen myself on this visit) having a shaking problem. You are wonderful people and this is a wonderful support group!
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I'm on my way out the door but I wanted to chime in... there are so many threads on here with advice about constipation so you might want to search the site and read them. Personally I would start with the simple tried and true, more fluids, prunes or prune juice, more fiber (but only if you can be sure he is getting enough fluids).
Miralax (PEG 3350) daily was truly a miracle for us, at least for a while. Stool softeners (colace) can also be added. Usually the next add in is senna (various brands), M of M is not really considered a gentle laxative but worth considering before moving on to the big guns. Good luck.
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