Had to call GP last week as mum had stomach pain and kept sitting on toilet. Sounds disgusting but she kept putting loo roll onto her rear end and looking at the stained paper not really understanding what was coming from her. GP said she is constipated, not opened her bowels for so long and was getting overspill. Inserted a pessary and prescribed orange drink sachets to help soften things. Can mum just have forgotten what toileting is all about? Anybody else come across this? I am putting incontinence pads on her cause she keeps leaking now.
Signal to open bowels gone?
- Thread starter Leswi
- Start date
She probably has not forgotten just having extreme difficulty because of dementia.
I have had IBS for around 20 years so am the complete opposite but for the last 6 months have had to take strong painkillers three times a day. These painkillers cause constipation. Great that I am not running to the toilet every time I eat but horrendous because no matter how hard I try to go I cannot manage it. So now I use lactalose to soften and help me.
I know what to do and I do it but nothing moves and this maybe what is happening to your Mum.
I have had IBS for around 20 years so am the complete opposite but for the last 6 months have had to take strong painkillers three times a day. These painkillers cause constipation. Great that I am not running to the toilet every time I eat but horrendous because no matter how hard I try to go I cannot manage it. So now I use lactalose to soften and help me.
I know what to do and I do it but nothing moves and this maybe what is happening to your Mum.
Do you know that incontinence pads are available free, well the equivalent to 3 a day, via a referral to the district nurse who then refers you on for a delivery of pads. Might not be many but better than nothing.
Hello Leswi
My mum often suffered with constipation and sometimes by passing, like it sounds your mum may be.
Apologies if you already know this
hope no one is eating as it's a bit graphic.
By passing means the person is badly constipated but liquid faeces pass by the blockage.
It can be cleared by medication that softens things up, you know when it's worked as the results can be spectacular.
I suggest you contact the GP and explain what is happening.
In the end we had mum on a preventative daily does of Movicol which helped a lot.
One district nurse explained it was likely mums muscles had got too weak to move things along.
My mum often suffered with constipation and sometimes by passing, like it sounds your mum may be.
Apologies if you already know this
hope no one is eating as it's a bit graphic.
By passing means the person is badly constipated but liquid faeces pass by the blockage.
It can be cleared by medication that softens things up, you know when it's worked as the results can be spectacular.
I suggest you contact the GP and explain what is happening.
In the end we had mum on a preventative daily does of Movicol which helped a lot.
One district nurse explained it was likely mums muscles had got too weak to move things along.
From our experience, I sometimes wonder how many people living with dementia are said to be incontinent of faeces when, in fact, they are just constipated?
Movicol has pretty much cornered the market in constipation remedies though there are many others, virtually all of which my wife was prescribed, along with Movicol, to no avail. Turning constipation into diarrhoea is not an answer to the problem and this was what all the remedies did, even when different dosages were tried.
I've written about this on my blog (I never expected to!) and I'm posting an extract here in the hope that it might help others:
I have described my wife as doubly incontinent as that is how she would be described medically, and the continence specialist to whom we were referred assumed that this would now be a permanent symptom of the condition. Urinary incontinence usually strikes first and those who believe in 'the stages of dementia' put it in the later stages and remark that late stage dementia often involves double incontinence.
I've always thought it odd that for S things developed the other way round. Like so many people, S had a longstanding tendency towards constipation. So when, three years ago, she started to have soiling problems, we used any number of laxatives and other drugs which various medics swore by. They turned out to be worse than useless. They simply complicated the issue and, whatever dose of whatever drug you used, you never really knew if there was any progress. Sometimes there seemed to be, but then you were suddenly back to square one.
Fast forward three years. For weeks now, there hasn't been a problem. S has emptied her bowels around 4 times a week and is completely clean all the time, i.e. 100% goes down the pan. This hasn't been achieved suddenly of course. There have been false hopes in the past but overall things have gradually improved over time.
How has this been achieved? I expect that this is what some carers reading this will want to know. So these are my tips, mostly discovered by trial and error:
1) Regular exercise, e.g. we aim to walk at least 5 miles a week whatever the weather and we usually exceed this target.
2) Vegetables are very important. We tend to eat a lot (we don't eat meat). Some vegetables are extremely effective - carrots, sweet potatoes, squash, onions all work well for S so I concentrate on these every second and, if necessary, third day.
3) Insoluble fibre, particularly wheat bran and anything that contains it, has to be treated with caution as it can have exactly the same unwanted effect as the drugs.
4) Soluble fibre, in particular oat bran, is great and much of the improvement can be traced back to when we started to have porridge for breakfast - real porridge not instant refined muck.
5) We discovered that immediately after the evening meal was the optimum time for a successful visit to the loo. If there is no result at first, I have found that a fruit dessert, e.g. apple crumble, nearly always does the trick.
6) Before every meal I give S fruit finger foods - mango, melon, apple, pears. I've always understood the importance of fruit but this fairly recently introduced tactic means that S eats more fruit than she did before.
7) Obviously, it's also important to keep hydrated and this is sometimes difficult - S has to be watched to avoid spills and she sometimes drinks very slowly.
Several months on from that entry, I can report that my wife was completely continent for four months. Now her bowels operate normally nearly every day. She started to have occasional lapses after the four months and these continue - about once fortnight. Compared with what I had to cope with for 3 years, this is very manageable.
Now, for what it's worth, I wouldn't touch Movicol or any of the others with a bargepole but it's obvious they work for some people.
Movicol has pretty much cornered the market in constipation remedies though there are many others, virtually all of which my wife was prescribed, along with Movicol, to no avail. Turning constipation into diarrhoea is not an answer to the problem and this was what all the remedies did, even when different dosages were tried.
I've written about this on my blog (I never expected to!) and I'm posting an extract here in the hope that it might help others:
I have described my wife as doubly incontinent as that is how she would be described medically, and the continence specialist to whom we were referred assumed that this would now be a permanent symptom of the condition. Urinary incontinence usually strikes first and those who believe in 'the stages of dementia' put it in the later stages and remark that late stage dementia often involves double incontinence.
I've always thought it odd that for S things developed the other way round. Like so many people, S had a longstanding tendency towards constipation. So when, three years ago, she started to have soiling problems, we used any number of laxatives and other drugs which various medics swore by. They turned out to be worse than useless. They simply complicated the issue and, whatever dose of whatever drug you used, you never really knew if there was any progress. Sometimes there seemed to be, but then you were suddenly back to square one.
Fast forward three years. For weeks now, there hasn't been a problem. S has emptied her bowels around 4 times a week and is completely clean all the time, i.e. 100% goes down the pan. This hasn't been achieved suddenly of course. There have been false hopes in the past but overall things have gradually improved over time.
How has this been achieved? I expect that this is what some carers reading this will want to know. So these are my tips, mostly discovered by trial and error:
1) Regular exercise, e.g. we aim to walk at least 5 miles a week whatever the weather and we usually exceed this target.
2) Vegetables are very important. We tend to eat a lot (we don't eat meat). Some vegetables are extremely effective - carrots, sweet potatoes, squash, onions all work well for S so I concentrate on these every second and, if necessary, third day.
3) Insoluble fibre, particularly wheat bran and anything that contains it, has to be treated with caution as it can have exactly the same unwanted effect as the drugs.
4) Soluble fibre, in particular oat bran, is great and much of the improvement can be traced back to when we started to have porridge for breakfast - real porridge not instant refined muck.
5) We discovered that immediately after the evening meal was the optimum time for a successful visit to the loo. If there is no result at first, I have found that a fruit dessert, e.g. apple crumble, nearly always does the trick.
6) Before every meal I give S fruit finger foods - mango, melon, apple, pears. I've always understood the importance of fruit but this fairly recently introduced tactic means that S eats more fruit than she did before.
7) Obviously, it's also important to keep hydrated and this is sometimes difficult - S has to be watched to avoid spills and she sometimes drinks very slowly.
Several months on from that entry, I can report that my wife was completely continent for four months. Now her bowels operate normally nearly every day. She started to have occasional lapses after the four months and these continue - about once fortnight. Compared with what I had to cope with for 3 years, this is very manageable.
Now, for what it's worth, I wouldn't touch Movicol or any of the others with a bargepole but it's obvious they work for some people.
Thanks Stanleypj
that worked for mum when her dementia wasn't to bad and was mobile.
When her tastes changed and mobility got bad we started to have problems . She didn't drink nowhere near enough either but always enjoyed her bowl of very sweet runny porridge in the morning.
I am glad you have solved the constipation problem
that worked for mum when her dementia wasn't to bad and was mobile.
When her tastes changed and mobility got bad we started to have problems . She didn't drink nowhere near enough either but always enjoyed her bowl of very sweet runny porridge in the morning.
I am glad you have solved the constipation problem
Thanks StanleyPJ for your advice. Mum's diet could certainly do with some more fruit and veg. She's no longer mobile so the exercise is not possible. I have now got her a special glass for water that I am going to try to get her to drink as that has been an issue for a while.
Laxido which used to be Movicol is for getting things moving. Lactulose is a softening agent but does not push so aggressively. I buy heaps of fruit. Due to being on Warfarin I have to limit C's intake of brassicas but have increased it and to every other day and they will have to sort dosage via INR. We ate many salads which I have reduced as not so 'pushy'.
As regards using fingers. Same here and it is because not only are drugs constipating but diverticulitis causes pockets where faeces get stuck. So I give plastic gloves and try to remember to remind usage of these disposables as I could not bear the smell of faeces sitting next to me declaring that fingers have been washed so well (is partially sighted!).
The increased use of broccoli, cabbage has helped. Fluids need to be pushed and walking is not possible. Lately success occurred every day but still exhausting. Wholemeal products-doesn't appreciate porridge. Eats oatcakes though. I know when laxative has gone too far, as it seeps out on its own. Hope thigsgobetterfor you. I hardly administer Laxido these days. Gettin touch with continence service as they actually give good products but as said earlier only 3. Does mean don't have to buy so many but I always order fro same people that continence service provides.
As regards using fingers. Same here and it is because not only are drugs constipating but diverticulitis causes pockets where faeces get stuck. So I give plastic gloves and try to remember to remind usage of these disposables as I could not bear the smell of faeces sitting next to me declaring that fingers have been washed so well (is partially sighted!).
The increased use of broccoli, cabbage has helped. Fluids need to be pushed and walking is not possible. Lately success occurred every day but still exhausting. Wholemeal products-doesn't appreciate porridge. Eats oatcakes though. I know when laxative has gone too far, as it seeps out on its own. Hope thigsgobetterfor you. I hardly administer Laxido these days. Gettin touch with continence service as they actually give good products but as said earlier only 3. Does mean don't have to buy so many but I always order fro same people that continence service provides.
Mum had AD for 15 years. At 1stage she became constipated and the GP prescribed various laxatives with limited success. They never got to the root of the problem and we ended up with a constant cycle of constipation then diarrhoea . I was told to try linseeds by the continence nurse and this was very successful. It took about 3 weeks to establish a routine and then the problem was resolved. I would put 2dessert spoons of linseeds in her weetabix every morning and sit her on the loo after breakfast- result everyday. It took a while to work out the amount of seeds needed to get a routine and it was trial and error. There are no nasty side effects with the seeds and she didn't notice them in her breakfast if I used hot milk and made it sweet and mushy. It is a very natural way to establish and maintain a routine.
My mum has lost all awareness of her bowel needs. She doesn't soil her incontinence pull-ups though because she doesn't seem to have the urge to evacuate.
When she gets constipated she says she is worried, or sad, which is her way of saying she feels uncomfortable. Even more fluids are necessary then, plus increased fruit, jelly, yoghurt etc. Sometimes she has Movicol, but only very occasionally as it causes unpleasant looseness.
Her breakfast includes a small bowl of mixed fruit with a couple of prunes. She eats fish and chicken, and I discourage too much meat, especially pork. Salty foods are dehydrating, and meat slows the digestion. Plenty of fruit and vegetables is best, with a small amount of light protein. She is given drinks little and often throughout the day.
Her carers can usually get her to do a successful BM when she's on the toilet after a meal. The digestive process after eating gets things moving. We naturally get the urge to defecate when in a crouched position, which is counter-acted to an extent by pressure on the back of the thighs when seated. Positioning on the toilet is therefore important. My mum has a toilet frame with handles. She can be positioned in a seated crouch, holding the handles for support.
Her carers say she seems unaware of the BM as it happens. It just seems to fall out. Since she is not straining to empty her bowels I would think they may not void as effectively as if she had awareness. All the more reason to avoid constipation by keeping up her consumption of fluids and watery foods.
When she gets constipated she says she is worried, or sad, which is her way of saying she feels uncomfortable. Even more fluids are necessary then, plus increased fruit, jelly, yoghurt etc. Sometimes she has Movicol, but only very occasionally as it causes unpleasant looseness.
Her breakfast includes a small bowl of mixed fruit with a couple of prunes. She eats fish and chicken, and I discourage too much meat, especially pork. Salty foods are dehydrating, and meat slows the digestion. Plenty of fruit and vegetables is best, with a small amount of light protein. She is given drinks little and often throughout the day.
Her carers can usually get her to do a successful BM when she's on the toilet after a meal. The digestive process after eating gets things moving. We naturally get the urge to defecate when in a crouched position, which is counter-acted to an extent by pressure on the back of the thighs when seated. Positioning on the toilet is therefore important. My mum has a toilet frame with handles. She can be positioned in a seated crouch, holding the handles for support.
Her carers say she seems unaware of the BM as it happens. It just seems to fall out. Since she is not straining to empty her bowels I would think they may not void as effectively as if she had awareness. All the more reason to avoid constipation by keeping up her consumption of fluids and watery foods.
Surely a person's awareness of defecation is not as important as the issue of whether they only defecate when on the loo? It's sometimes very difficult to tell what a person living with dementia is/ is not aware of.
And I'm not sure whether, ideally, a person should have to 'strain' to void effectively. There are clear and well-known dangers involved in straining.
And I'm not sure whether, ideally, a person should have to 'strain' to void effectively. There are clear and well-known dangers involved in straining.
linseeds
Like barny, I heard from a continence nurse that linseeds were a gentler remedy than the usual treatments offered. The lady in the healthfood shop told me to buy whole linseeds (ie. not ground linseeds) and to soak them in water, as this causes the seeds to swell, and release the gel-like substance that helps get things moving.
I soak them in just enough water overnight, and then put them onto breakfast cereal. They work effectively but result in 'normal' bowel movements, not the 'runs'.
Without soaking, the seeds are hard and get stuck in one's teeth, and I don't think even drinking lots of water with them would be as effective.
She said that ground linseeds are very good for you, but not as a remedy for constipation.
Like barny, I heard from a continence nurse that linseeds were a gentler remedy than the usual treatments offered. The lady in the healthfood shop told me to buy whole linseeds (ie. not ground linseeds) and to soak them in water, as this causes the seeds to swell, and release the gel-like substance that helps get things moving.
I soak them in just enough water overnight, and then put them onto breakfast cereal. They work effectively but result in 'normal' bowel movements, not the 'runs'.
Without soaking, the seeds are hard and get stuck in one's teeth, and I don't think even drinking lots of water with them would be as effective.
She said that ground linseeds are very good for you, but not as a remedy for constipation.
Awareness is relevant when another person has to take over managing the toileting process. The caree can lose the ability to interpret signals from their own body. Without assistance they would eventually defecate elsewhere than on the loo. Managing toileting effectively preserves their dignity as well as their hygiene.
I agree, straining with effort is dangerous. I suppose I meant pushing not straining.
My mum is not aware of defecation. She understands what it means but just doesn't feel it happening. She also has no bladder control and is unaware of the sensation of urinating. Success with toileting her seems to be a matter of choosing the right moment and the effect of removing clothing and exposing her skin to the air. Similar to toddlers on the pot.
Drinking lots of water can solve the problem of constipation or constipation with overflow. The trouble is getting people with dementia to drink enough water. My mum will hardly drink at all. You can spend hours going on and on at her trying to persuade her. I have found that she does like Earl Grey tea which is one way of getting her to take liquids. I have also been told by doctors that it helps if sufferers take exercise.
Thanks very much for all the information in this thread - I didn't realise that constipation could come with overflow that presents like diarrhoea - I have now started to give OH his Fybogel again. First sachet this morning and 5 minutes later he did a first class poo - result.
I thought we were the only ones!
Thanks to everyone who contributed to this helpful thread. My mum (undiagnosed but very worrying memory symptoms) has been struggling with constipation for months - I'll mention it now when we go to the memory clinic in two weeks.
Last week she had a huge bowel movement which I found at the end of the sofa wrapped in her knickers... I am sure she had no recollection of passing it, though it was big enough to block the toilet ...
Have recovered but want to avoid this happening again. We've tried movicol and laxido and found they caused a horrible combination of constipation and awful diahorrhea - one morning she wheeled her zimmer through an 'accident' and then walked around her sheltered flat with the zimmer trailing poo everywhere. That was fun.
I'm currently feeding her bean soup, baked beans on toast, fresh orange juice (she refuses oranges) apple puree mixed with dried fruit and linseeds in her muesli. Bran fruit bread and bran in the muesli too. All trial and error - any comments gratefully received. Thank you!
Thanks to everyone who contributed to this helpful thread. My mum (undiagnosed but very worrying memory symptoms) has been struggling with constipation for months - I'll mention it now when we go to the memory clinic in two weeks.
Last week she had a huge bowel movement which I found at the end of the sofa wrapped in her knickers... I am sure she had no recollection of passing it, though it was big enough to block the toilet ...
Have recovered but want to avoid this happening again. We've tried movicol and laxido and found they caused a horrible combination of constipation and awful diahorrhea - one morning she wheeled her zimmer through an 'accident' and then walked around her sheltered flat with the zimmer trailing poo everywhere. That was fun.
I'm currently feeding her bean soup, baked beans on toast, fresh orange juice (she refuses oranges) apple puree mixed with dried fruit and linseeds in her muesli. Bran fruit bread and bran in the muesli too. All trial and error - any comments gratefully received. Thank you!
Tomjo, re my earlier post on this thread, my wife has continued to 'perform' when sitting on the loo almost every day and nearly always at the same time after the evening meal. Our experience of Movicol etc mirrors yours. The laxative industry is colossal and yet vast numbers of people are, apparently, permanently constipated. Something wrong somewhere.
To sum up what has worked for us, vegetables and fruit are key (loads of them), as is exercise. It was also noticeable that things improved after we started avoiding wheat bran. It was all trial and error.
It is more difficult to stick to the regime when we are away from home but it only takes a couple of days to get back to normal.
So, after three years when my wife was incontinent of faeces, she now isn't. Even those who haven't (yet?) experienced faecal incontinence day and night may appreciate the difference this has made to our lives.
To sum up what has worked for us, vegetables and fruit are key (loads of them), as is exercise. It was also noticeable that things improved after we started avoiding wheat bran. It was all trial and error.
It is more difficult to stick to the regime when we are away from home but it only takes a couple of days to get back to normal.
So, after three years when my wife was incontinent of faeces, she now isn't. Even those who haven't (yet?) experienced faecal incontinence day and night may appreciate the difference this has made to our lives.
This is an amazing thread - thank you all.
My mum lives alone in a tiny 'sheltered' flat. No care is provided through the scheme, so I have got Carers in, which mum absolutely hates - even though they are are only there for 15 mins a day.
Mum has begun to soil herself and to 'hide' the results of bowel movements in bags around her flat. She doesn't seem aware / distressed by this, but it's difficult to tell.....
I go once a day, clean up, encourage her to eat and drink, etc. I stay about 4 - 5 hours a day. We don't go out much as mum's arthritis makes walking very difficult.
All the advice on here is wonderful, but it seems to me that I would need to (almost) live at mum's to carry it out. There isn't a spare room or even a spare bed. Does anyone have any thoughts on whether it seems likely we'd be able to resolve mum's problem in her current circumstances? I am not there at breakfast and I know she doesn't drink enough, or eat well, for instance.
Can we avoid residential care? Should we try?
Sorry, just got back from a short break so hope I'm making sense......
Lindy xx
My mum lives alone in a tiny 'sheltered' flat. No care is provided through the scheme, so I have got Carers in, which mum absolutely hates - even though they are are only there for 15 mins a day.
Mum has begun to soil herself and to 'hide' the results of bowel movements in bags around her flat. She doesn't seem aware / distressed by this, but it's difficult to tell.....
I go once a day, clean up, encourage her to eat and drink, etc. I stay about 4 - 5 hours a day. We don't go out much as mum's arthritis makes walking very difficult.
All the advice on here is wonderful, but it seems to me that I would need to (almost) live at mum's to carry it out. There isn't a spare room or even a spare bed. Does anyone have any thoughts on whether it seems likely we'd be able to resolve mum's problem in her current circumstances? I am not there at breakfast and I know she doesn't drink enough, or eat well, for instance.
Can we avoid residential care? Should we try?
Sorry, just got back from a short break so hope I'm making sense......
Lindy xx
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If she isn't keen on plain water, and people with dementia sometimes aren't, you could try squash. My mother's CH give them all several small glasses of weak orange or blackcurrant squash throughout the day, since many of them just won't drink plain water. Of course water is healthier, but it's a lot better than not drinking.
