Constipation - Need ideas...

Hi,
I am an Rn but know very little about the elderly...

My 90 yr old grandmother is in an LTC facility. She has many physical limitations but is mentally competent but her memory is poor.

Two years ago she had a bowel obstruction. Every since then she has been incontinent. Her elimation pattern however is pretty much constipation for a few days followed by diarrhea for a day then back to no BM for a few days. This repeats over and over...she has has extermemly bad hemmroids which cause her almost unbearable discomfort when she is constipated. (She attempts to manually disimpact herself when constipated)

The bowel routine the home has her on is colace in the am, senekot (2 tabs) at hs. She also gets lactulose at hs. She also has the option of MOM prn at her request but rarely thinks to ask for it. She also eats prunes at breakfast. Obviously IMHO this isn't really working as she spends 2-3 days in agony (constipated) and a day with incontinent diarrhea. This is the homes regular protocol...however the doctor and nurse are both open to my suggestions of other things to try.

so I'm wondering what you do in your facilities, what are your bowel protocols for constipation....I'm hoping to get some other ideas that I can look up and read about and then bring to the doctor and discuss with him. He is only there once every couple weeks for about an hour so I have to come prepared as my time with him is brief!

Thanks!