HORRIBLY painful bowel movements-help

UM Review RN, ASN, RN · Jul 9, 2005

So what's the dosage of his stool softeners? Would it be a horrible thing if he relied on Dulcolax? Sennakot? Glycerin suppositories?No one should have that kind of pain every day to move the bowels.

How much exercise does he get? How much water is he drinking? How about fiber? My friend says it's 2 cups of coffee that does the trick for her. Even though he's on pain medications, there are therapies that can help.

Also, leave some distracting reading material in the bathroom. It might help him to relax by reading magazine articles instead of concentrating on going and thinking about the resulting pain.

As always, everyone is different. Your husband needs to address this and discuss strategies with the appropriate doctor.

palesarah · Jul 9, 2005

I know this sounds simplistic, but are you sure he's not just really constipated? That he's holding back from moving his bowels so much that they become rock hard and painful to pass (that in itself can be a cause for blood in the stool). Something similar is seen a lot in little kids who either aren't really ready for toilet training or just don't like it, sometimes in special needs kids too- they resist it to the point that their stools become dry/hard/painful- and then hold it longer the next time, making it worse, and so on. WHat sometimes starts as a pyschological thing- someone for some reason doesn't want to move their bowels- can become a painful physical problem, but one that can be treated pretty easily (stool softeners, sometimes glycerine suppositories, etc)

This isn't something I've really encountered in my nursing practice but I known a couple people who have had this problem with their sons. Just thought I'd mention it in case it hadn't been considered yet...

nursejoey05 · Jul 9, 2005

I have asked all the doctors about stool softeners and such. We tried sennakot with no results. He takes a large dose of lactulose, but that doesn't seem to help. I keep asking "what else"??? The problem I encounter with the docs is that they seem to dismiss this as just something that is going to happen based on his disease process, and I don't find that to be acceptable. He gets absolutely no fiber in his diet. In fact, his daily diet consists of peanut butter and jelly on white bread, little debbie brownies and frozen waffles. He has mouth sores/pain and problems with his dentures because he has gained and lost so much weight. The other problem is that he doesn't want me to have to attend to his toileting needs. My father was diagnosed with stage 4 cancer, so I immediately moved him in with us. During the 10 months that he lived here, I had to give enema and remove impactions frequently. My husband saw me go through that with my dad and doesn't want me to have to do it for him. (Obviously it's not a big deal with me, and especially if I could do something to ease the suffering of the man I love. :crying2: ) I feel like we need to start completely over with a bowel elimination plan, but I'm still just a student and don't quite know quite where to start. I don't want to "reinvent the wheel", but seems like I'm on my own if all these docs aren't going to treat it as the issue I think it is. Thanks for listening!

babynurselsa, RN · Jul 9, 2005

at the very least he should be on some docusate/senna. he could have 1-4 BID if that is ineffective you might want to consider some lactulose. The rock hard sttols are very common in pts on lots of opiods, and less active patients. Hope this helps

txspadequeenRN, BSN, RN · Jul 9, 2005

Well first Im sorry to hear of your husbands sickness. Constipation is very common in patients taking lots of pain meds. If it were me I would be giving him prune juice every day maybe mixed with some benifiber. When I have to blow out a patient I use 8 ounces prune juice, 30cc's Lactulose and 30 cc's MOM. Mixed together ,then warmed. I have in the past used this and it works wonders. Mix 1/2 c milk and 1/2 c dark molasiss and give it as a enema. Of course I am not a doctor so please check with your doctor if you have questions.

hollyster · Jul 9, 2005

Have you tried SennaPrompt, Each dose is 500 mg psyllium and nine mgs of sennoside? Take it with at two 8oz glassess of H2O or juice. Coffee will speed up the effect. Just make sure you drink two full drinks.

Antikigirl, ASN, RN · Jul 9, 2005

Well...in addition to all those stool softeners and laxatives (which I really think you will have to use very routinely several times a day), setting up a schedule is a great idea too!

Now, for most of my more constipated residents, they find it best to have a bowel movement once every 2-3 days after a hot shower or bath (bath tends to work better). They drink a cup of warm prune juice before the bath, a bit of MOM if they need it...and then grab a book and sit down after for a while .

Training the body to do that at certain times helps :).

As far as some anxiety about heart probelms on the toliet, consider discussing some type of communication device so that he can feel more secure in case he feels dizzy/weak/odd/etc. Men typically won't discuss this openly, but maybe a walkie talkie or even just a bell will help him to feel more secure with fears knowing you are just a sound away to help! (I find bells work well...walkie talkies work too, but lets face it...who wants to grunt/cry out on a walkie!?).

Covering the BM's texture (softeners), the freqency (laxatives and scheduled times), and his anxiety/fears (bell, and open discussion) will cover the major parts of the issue. Also looking into proper pain managment (medications or nonmedication) with constipation in mind will do wonders (I suggest a pain management specialist)!

Good luck to you, and great question. So many people throw up their hands in defeat over these issues just saying "well that is the way it goes"...you didn't! KUDOS!

mattsmom81 · Jul 9, 2005

I have IBS with constipation, and my meds have aggravated the constipation so nothing worked anymore, either. Not prunes, not fiber, not stoolsofteners etc.

My doc prescribed Glycolax...which is a clear powder you mix with 1/2 glass of liquid. It is odorless and tasteless and taken once a day. It pulls fluid into the bowel to soften the stool and works very well for me. You may wish to ask his PCP for an RX.

Hope you find something that works....I'm sorry your hubby is so ill.

MIA-RN1, RN · Jul 9, 2005

What do you do when someone has horribly painful bowel movements. This is my husband who is terminally ill with myelodysplastic syndrome and liver. I have compained until I'm blue in the face and the response is "they shouldn't hurt that bad".
We have some very good doctors, but...
I have asked his liver specialist (famous guy)
I have asked his MDS specialist (famous guy)
I have asked his oncologist (not so famous guy)
I have asked our family practitioner
I have asked our new internist.
I am frustrated. It hurts so bad he literally screams in pain, and I really feel like he is going to die right then. It sends such a horrible feeling through me.
I have checked him for hemmorhoids (none). I have checked for impaction. It seems to me that his stool is not being pushed down his colon effectively. He will have a bowel movement and it won't all come out. Of course there is visable blood in every movement. It is affecting him psychologically, also. His father died of a heart attack on the toilet. His mother died of a pulmonary embolism on the toilet. He is afraid to have a BM if I am not here, so he doesn't respond to the urge. Tonight he is in tears because he has had 4 BM's in the last 24 hours, each more painful than the last. I finally convined our new doctor to do a colonoscopy, but it's not until next month. (His mother had colon polyps.) Oh, he is on major doses of narcotics, but has been for many years and this has not been a problem until the last 6-12 months. One more "unexplainable" thing, according to the docs, his stool is rock hard balls. He had been telling me that it was hard, but I didn't know how hard until I did the hemoccult test. I could hardly cut into them to get a sample. And then I when I was cutting into one it flicked out of the top hat and fell on the floor with a loud thud. If it had hit my foot, it would have hurt :rotfl: (sorry-have to have a sense of humor or I'll go fetal) I know you're not supposed to ask for medical advice on here, but I
am just so frustrated. I would feel bad for a patient in this shape, but it really hurts to hear my husband scream and to see him cry. Thanks!

I am still astudent myself, but wouldn't something like the drinks they give you to 'clean you out' as a bowel prep help get things moved, and then a daily metamucil?

ktwlpn, LPN · Jul 10, 2005

I have asked his liver specialist (famous guy)

I have asked his MDS specialist (famous guy)

I have asked his oncologist (not so famous guy)

I have asked our family practitioner

I have asked our new internist.>>>>>>

Forget about those guys-you need a nurse right away......-one whom is experienced in hospice care and these issues.....We have many great ones here on this site....You need to give yourself time to be his wife and partner,too....Ask your physician about home health care to assist you....I've seen people take alarming amounts of softeners(up to 6 peri-colace twice a day) and laxatives due to long term narc use.....Take care of yourself,too......Good Luck....

Faeriewand, ASN, RN · Jul 10, 2005

My mother is a home health aid and the advice she has gotten on this subject was to give the person yogurt with live culture at every meal. A spoonful before and a spoonful after works for most. Also, taking pills put in a spoonful of yogurt helps them go down easy. Reduce the amount of meat eaten in one sitting. And yes, her elderly patients would not respond to prune juice and other foods. That is what she told me.