Constipation - Need ideas...

[Meraki]

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!

[LadyQT]

MOM "Milk Of Magnesia"

[NRSKarenRN, BSN, RN]

check out:

bowel irregularities and incontinence

by diane k. newman, rnc, msn, crnp, faan

fecal impaction

"special bran recipe"

given this out to hundreds of patients with 99.5% satisfaction.

[seaspray]

Let me preface by saying I do not have experience on this treatment with those who are mobility restricted, but it has worked well on the mobile! I know of no reason why it would not help for the infirm also. I have even tried it myself due to severe constipation caused by medications.

My preference is Cascara Sagrada, an herbal supplement. From personal experience, I was having to use 400mg Colace BID and Dulcolax on a weekly or bi-weekly basis to achieve any sort of regularity. Movement of the bowel was still painful and difficult with this regemin. A friend guided me to Cascara Sagrada, and I am amazed at its effectiveness. Rather than overstimulating the bowel to a painful evacuation, it seems to awaken and coordinate the natural bowel contractions. Voila! A working bowel! It is taken as one 450mg dose daily. Through research I have done, I have not been able to find information on a dosing schedule for continuous usage. A dose of Cascara Sagrada every other day along with 200mg Colace BID seems to be effective without any unwanted side effects. As stated in other posts, adequate fluid intake is also necessary.

Hope this works for you and others!

[allevi]

Milk of Magnesia = MOM

Sorry, when I responded, didn't see the other answers

[rhondaa83]

Milk of magnesia

[Merced]

MOM is milk of magnesia.

The power mixture sounds like a great idea - the 2 fruits should provide the fluid needed to absorb the bran & move it on through :)

Here are several other things which I found useful:

Toileting at the same time every day, according to the patient's body pattern, and elevating the feet on a footstool.

Prune juice really is Magical - but much more effective if not cold, as someone mentioned already. I actually found that mixed with or followed by hot water works even better than just warming up the juice, and the proportion of juice to water doesn't seem to matter, strangely enough.

Bran flakes, bought in bulk, can be added to many foods without being noticeable.

Activity is so important, and it is essential to keep track, and have a plan which goes into effect immediately - an ounce of prevention is probably worth a ton of cure!

Some tricks to hold in reserve, and not use regularly:

Smooth Move tea

Bisacodyl pills

Glycerin suppository

And the dynamite: MoM with cascara.

[husker_rn, RN]

i worked in a facility that made " Recipe ". It was bran, raisins, apples oranges, and prune juice. Consistency was a bit thicker than applesauce and 30 cc once or twice a day could give the most constipated episodes of diarrhea. Usually 15cc/day kept the folks with problems going.

[Merced]

This topic is one of my favorites in nursing - doctors don't seem to see this problem as a worthy challenge, leaving it to us nurses - YES!

I am convinced that constipation is at the root of many discomforts, and worse, of old age.

My grandma used to be "anal" about us having a movement every day, and I bet everyone's gran or great-gran was the same: possible, before scientific medicine, people were aware of how important it was to at least keep the alimentary canal active.

When I was a home health case manager, I took a lot of pride in being sure to ask the question, and then following through with a program. It was very gratifying, even though not glamorous :)

AND, I understand my Grandma a bit more.

[aloha551]

The Atom Bomb of laxitives (MOM and prunejuice) followed by an afternoon in the resident lounge area being entertained. The Bomb relaxes the bowels(not realy) and the entertainment relaxes the resident. Presto everyone is scrambling, wheel chair included to the nearest facility. Never fails to work. Works even faster if she is being entertained by a group of elderly barbershop singers. I have witnesses this happen. Thought I'd add some levity to a very somber issue

[nightmare, RN]

There was way I forgot to mention but this would depend on the Facility's policies and having someone qualified to do it..Reflexology...Now don't ask me how it worked but it did.In fact it was too successful!After having to clean up several different rooms we decided to stop using this.It is non invasive,very relaxing and uses no chemicals.

[poohmdsnurse]

Milk of Magnesia

[Tash4nvyblues, RN]

thanks everyone, I now know what MOM stands for. What a great response (LOL). You hit the nail on the head with the cranberry juice. If your grandmother can swallow cranberry tablets, that would be even better, because it is a concentrated dose given every day and it works.