Constipation matters...

[Rageddy Anne]

WARNING. IF YOU ARE SQUEAMISH YOU MIGHT NOT WANT TO READ ON!

I think my husband is severely constipated. He was in a care home where there he experienced a constipation/ laxative regime which I don't think resolved the problem. We found him a better care home, but I'm certain he is now constipated again.

His breath is foul, and he is very distressed, and yesterday be was producing what looked like rather large firm rabbit droppings. The effort to produce these was obvious, and it was distressing to see him desperately trying to remove them using his fingers! ( sorry)

I believe he has lost the ability to understand the procedures for using the toilet. He doesn't understand that he must sit down, and once he is sitting, he doesn't understand the need to push.

When I asked the care home nurse about it she said he was getting laxatives twice a day, and must drink plenty of liquid but must help himself by not refusing drinks... As if he's being difficult.....HE DOESNT ALWAYS UNDERSTAND, but he will drink if I demonstrate what to do, and I can get plenty of liquids down him. So can most of the carers.

I've read a little about something called faecal impaction, and I think that's his problem...the laxatives result in runny faeces, but there is also a solid mass in his intestine that does not get passed through.

As a result of this toxicity I think his whole system is being affected, and could be the cause of some if his physical discomfort and distress, his itchy skin and perhaps even his angry outbursts.

Has anyone else had any experience of something like this? I feel that the nurse is doing things by rote, and not listening to my concerns...She refers to the GP as though he is the only person responsible for my husband's health, and it isn't my place to have an opinion. When I gently mentioned being my husband's next of kin she said that I needed Power of Attorney, and when I said I have that, she snapped back with " well, it must be registered then".

Hers must be a challenging job; I can see that relatives can be a nuisance, and I try not to be troublesome, but on this I do feel I should be listened to.

Any suggestions would be welcome...

 

[Katrine]

I think your analysis of the problem is spot on. I am sorry to hear that the nurse is being unhelpful. Blaming the PWD shows a lack of empathy and understanding of his condition. It's shameful that she is so casual about it when you've already seen how your OH is suffering from the build-up of toxins.

Faecal impaction is a medical problem and OH needs treatment to remove the blockage. I would contact his GP as a matter of urgency to discuss what can be done when the patient has dementia. If you want to know the treatment options then Dr. Google will tell you.

The longer the impaction continues the more difficult it is to remove. It may already be too big for a natural evacuation, even if OH could coordinate that. It's extremely painful to strain to pass a hard impacted motion. I bet nursie wants to avoid a messy treatment, but it may be necessary for her to take instruction from the GP. The alternative might be hospital. It really doesn't seem, from what you say, that this can be resolved without medical intervention.

You are right to be concerned, especially with the foul smell on his breath. A relative of mine had severe faecal impaction and eventually experienced faecal emesis, which was distressing and highly unpleasant. I quote from Wikipedia: "Fecal vomiting occurs when the bowel is obstructed for some reason, and intestinal contents cannot move normally. Peristaltic waves occur in an attempt to decompress the intestine, and the strong contractions of the intestinal muscles push the contents backwards through the pyloric sphincter into the stomach, where they are then vomited."

Sorry to scare you. That's worst case, but it's got to go somewhere, hasn't it?

 

[Shedrech]

hi Raggedy Anne
I wholly agree with Katrine
this happened to my dad a while ago, when I was wholly ignorant of such problems - he vomited up - they sorted him out in hospital - a few laxatives would not have touched the problem - afterwards he was on a much stricter regime of lots of fibre and lots of drinking!
personally, I 'd contact the GP direct and insist on your husband being carefully checked over - plead ignorance of procedures eg 'oh am I meant to contact you through the home? I have always just phoned up my husband's GP myself so did this automatically; never mind. When will you be there to see him, as I'll make sure I'm visiting then so hubby has me around for a bit of support ..'
best wishes

 

[hillymilly]

WARNING. IF YOU ARE SQUEAMISH YOU MIGHT NOT WANT TO READ ON!

I think my husband is severely constipated. He was in a care home where there he experienced a constipation/ laxative regime which I don't think resolved the problem. We found him a better care home, but I'm certain he is now constipated again.

His breath is foul, and he is very distressed, and yesterday be was producing what looked like rather large firm rabbit droppings. The effort to produce these was obvious, and it was distressing to see him desperately trying to remove them using his fingers! ( sorry)

I believe he has lost the ability to understand the procedures for using the toilet. He doesn't understand that he must sit down, and once he is sitting, he doesn't understand the need to push.

When I asked the care home nurse about it she said he was getting laxatives twice a day, and must drink plenty of liquid but must help himself by not refusing drinks... As if he's being difficult.....HE DOESNT ALWAYS UNDERSTAND, but he will drink if I demonstrate what to do, and I can get plenty of liquids down him. So can most of the carers.

I've read a little about something called faecal impaction, and I think that's his problem...the laxatives result in runny faeces, but there is also a solid mass in his intestine that does not get passed through.

As a result of this toxicity I think his whole system is being affected, and could be the cause of some if his physical discomfort and distress, his itchy skin and perhaps even his angry outbursts.

Has anyone else had any experience of something like this? I feel that the nurse is doing things by rote, and not listening to my concerns...She refers to the GP as though he is the only person responsible for my husband's health, and it isn't my place to have an opinion. When I gently mentioned being my husband's next of kin she said that I needed Power of Attorney, and when I said I have that, she snapped back with " well, it must be registered then".

Hers must be a challenging job; I can see that relatives can be a nuisance, and I try not to be troublesome, but on this I do feel I should be listened to.

Any suggestions would be welcome...

Hi. You are exactly right. This does sound like faecal impaction. It can show as "rabbit droppings" alternating with a watery discharge. He must be in so much pain.

My dad (who died from Alzeihemers 9 years ago) suffered terribly from constipation whilst in a CH. They were not very supportive, so yes, you should bypass the home and go direct to the GP.

 

[Rageddy Anne]

Update

WARNING FOR THE SQUEAMISH, look away now!

Hoping we've had a resolution...

Poor old lad, he was given laxatives twice a day, and yesterday, with most of the carers he knows being off duty, I found myself dealing with Surprise Diarrhoea just after lunch...just made it to the adjacent LOO in time!

Earlier, when I arrived, I had discovered two rather delightful ( not) faecal donations on the floor in his room, very firm indeed, volume approximately the size of two tennis balls..(They were very short staffed, unexpectedly, so may be forgiven).

When I told the Care Home Nurse from Hell she glared and said that constipation and diarrhoea couldn't happen together. I wanted to say I wished I had kept the evidence for her to see! Instead I repeated what I had said, smiled sweetly, and said I hoped that our problem had been solved...

A friend said she makes lentil soup for her husband (who is also in a care home) as lentils are a good source of fibre.

I can report that he was more peaceful and a little less agitated, so perhaps the 'blockage' has eased. The question now is, how to prevent it happening again.

 

[Rageddy Anne]

Thankyou...

THANKYOU for your replies and clear advice, hillymilly, Shedrech, and Katrine.

Apparently the GP was unavailable to visit, but must have prescribed the daily double doses of laxatives.

If this can happen in Care Homes, I wonder that more attention isn't paid to fibre in the diet. Now I'm wondering how to introduce more fibre into my husband's diet myself. Or perhaps the problem is more that he's forgotten how to "push".

 

[Grannie G]

Will your husband eat prunes Anne?

I found a few prunes daily with some porridge helped form a bowel movement where it was not necessary to `push` but where the motion passed easily without being too loose.

 

[LadyA]

Anne, I suffer (again, all, look away now if squeamish!) from a "lazy colon" since I was born. I really have to keep an eye on things, or I get very constipated. My usual diet consists of porridge with dried fruit and seeds in the morning and almost every day for dinner, I have home made vegetable soup with celery, carrots, onions, mixed beans, lentils, tomatoes, any kind of veg! And I drink lots. I can still get constipated now and then. I keep Lactulose on hand, and take a couple of tablespoons of that at night for a couple of nights every week. I did get impaction at one stage, and will never forget how ill I felt! I had to take Movicol sachets that you mix in water. Eight of them in one day, I had to take!! I was sure I would get horrible diarrhoea, but I didn't! It did shift the blockage, but only just.

If your husband is not drinking enough, be careful about filling him with fibre, as fibre needs a lot of fluid to get things moving. Otherwise, it will have the opposite effect! He needs fibre + fluid, and I would give him lactulose regularly too, which will keep the stools softer and less likely to impact and make them easier for him to pass.

 

[care 4 momma]

WARNING. IF YOU ARE SQUEAMISH YOU MIGHT NOT WANT TO READ ON!

I think my husband is severely constipated. He was in a care home where there he experienced a constipation/ laxative regime which I don't think resolved the problem. We found him a better care home, but I'm certain he is now constipated again.

His breath is foul, and he is very distressed, and yesterday be was producing what looked like rather large firm rabbit droppings. The effort to produce these was obvious, and it was distressing to see him desperately trying to remove them using his fingers! ( sorry)

I believe he has lost the ability to understand the procedures for using the toilet. He doesn't understand that he must sit down, and once he is sitting, he doesn't understand the need to push.

When I asked the care home nurse about it she said he was getting laxatives twice a day, and must drink plenty of liquid but must help himself by not refusing drinks... As if he's being difficult.....HE DOESNT ALWAYS UNDERSTAND, but he will drink if I demonstrate what to do, and I can get plenty of liquids down him. So can most of the carers.

I've read a little about something called faecal impaction, and I think that's his problem...the laxatives result in runny faeces, but there is also a solid mass in his intestine that does not get passed through.

As a result of this toxicity I think his whole system is being affected, and could be the cause of some if his physical discomfort and distress, his itchy skin and perhaps even his angry outbursts.

Has anyone else had any experience of something like this? I feel that the nurse is doing things by rote, and not listening to my concerns...She refers to the GP as though he is the only person responsible for my husband's health, and it isn't my place to have an opinion. When I gently mentioned being my husband's next of kin she said that I needed Power of Attorney, and when I said I have that, she snapped back with " well, it must be registered then".

Hers must be a challenging job; I can see that relatives can be a nuisance, and I try not to be troublesome, but on this I do feel I should be listened to.

Any suggestions would be welcome...

My mom is end stage 7E, dementia patients are constantly dealing with this problem. I take care of her at home and have her on a perfect regimen. I give her 3oz of Sunsweet prune juice WITH PULP and top it off with ice water and watermelon flavored Dasani drops to enhance the flavor every day at breakfast along with a high fiber diet. She has a BM daily, her stomach is checked by the hospice nurse weekly and we no longer have issues like we did when she first came to live with us 2 years ago. I hope this helps you I like to use natural methods not laxatives. Also anyone that spoke to me like your nurse did would be wishing she wasn't born when I got through with her!!

 

[Rosnpton]

We also keep liquorice sweets on hand,as these will be accepted by mum,even when decides won't eat anything
Ros

 

[At home]

Combatting constipation

Hi, my mum suffered from time to time, and she has been prescribed docusate by the gp which apparently is a stool softener - though I am not sure how it works, and if it can exacerbate dehydration. It stops her from getting so bunged up. We were told to start on 2 tabs a day, but you can go up to 4. 4 was too many for her, and caused on going leakage. We were also given movicol sachets, but she won't take them, because she isn't fussed on cold drinks. I use prunes & custard quite often to help things along and provide some fibre since her diet is mainly cakes, biscuits and ice cream (all I can get her to eat most times) and have found that she will take syrup of figs - it seems to be a sweetened version that you get in the shops now, and it seems quite pleasant.

 

[Jessbow]

Would he eat such as figs and dried apricots? Lildl ( Might be aldi, never remember which is which!) do bags of really sweet patially rehydrated one, soft to eat but do the job!!

 

[Risa]

I swear by Linwoods Milled Organic Flaxseed which Holland & Barrett or major supermarkets sell. You just need to have a couple of heaped dessert spoons every day which can be sprinkled into a yoghurt or cereal (Weetabix is perfect as it completely blends in ).

 

[Rageddy Anne]

There's a prescription now for Rob to have Lactulose as and when, but he was in trouble again recently, and so distressed. Better now, but it shouldn't happen...he can't always remember how to hold a cup for drinking, so I asked for his drinks to be in a beaker..weekend carers didn't know, and a cup was put in front of him....I watched, and the full cup was removed without comment.

This week he's been less sleepy, and could manage a cup again. AND he was able to pick up, and hold a glass of juice, drinking until it was empty. But his urine was still very dark...

Makes me think Care homes might benefit from having someone appointed to be something like a drinks monitor! OK, NOT PRACTICAL,but internal physical events do seem more important than some care homes treat them.

It's especially important when the weather is hot.

 

[Shedrech]

hi Raggedy Anne
it's good that your husband is less 'troubled'
in dad's care home the fluid intake of all residents is recorded each day - and when I went in on a particularly hot day it was quite clear that the staff were regularly making drinks for the residents, taking them round and doing their best to make sure as much was drunk as possible (sometimes a wanderer just will not sit still long enough, or someone point blank refuses, but the staff noticed this and tried them again in a still and accepting moment) - and those who have trouble using certain cups are given those beakers they can cope with - it's the senior's role to ensure the carers are on top of this especially in the hot weather
so I really don't think you are asking too much for fluid intake to be taken seriously
maybe have a chat with the manager?
best wishes