“Mama has had diarrhea all night and she refused to take anything for it,” was the greeting I received at the door from Mrs. Jeter’s exhausted daughter. We had just started working with Mrs. Jeter a week ago and I knew she had a history of constipation. When I walked in house Mrs. Jeter was sitting in the living room, looking miserable. Her stomach was swollen and firm.
“I’m compacted, aren’t I,” Mrs. Jeter asked, as I completed my assessment? I resisted the urge to automatically correct her misuse of the term. I knew what she meant and I suspected she was right. “I’ve been this way before and it feels the same.”
“It sounds like it but I’ll have to check,” I informed her.
“Oh, lovely,” she intoned sarcastically and I could not help but smile. I did not blame her because this would be far from fun for either of us, but Mrs. Jeter had a great sense of humor. “Come on and I’ll show you my butt.”
We went to her bedroom where I examined her and told her, “Yes, you’re impacted. I’m afraid I’m going to have to remove it. Sorry.”
“What’s that mean,” her daughter asked? I explained that sometimes feces becomes very hard and blocks the bowel and has to be manually removed by a physician or nurse.
“But she’s having diarrhea,” she argued.
I explained how the liquid was going around the hard feces and silently thanking Mrs. Jeter for having the good sense to refuse to take anything for diarrhea. “It’s a common mistake,” I continued, “but her abdomen is swollen and you can feel how firm it is.”
The elderly and their bowels. Not exactly your typical blog topic, but if you are taking care of an older parent, you probably are well aware of their constant worry about whether their bowels have moved today. It is the bane of every home care nurse’s existence.
One of the most common problems seen with the elderly is constipation and it can be more than just uncomfortable, it can also be dangerous. I have actually seen someone die because of severe constipation that completely blocked their bowel.
If constipation becomes severe enough, the feces will become hard and cause an impaction. The person may then have watery stools around the impaction, leading one to think they have diarrhea. If your prent’s stomach is large, rounded, firm to touch and they are having watery diarrhea then it is a safe bet that they have a fecal impaction and it needs prompt treatment. Please consult you healthcare professional.
I worked to remove Mrs. Jeter’s misery and followed up with an enema. I knew she was feeling better when she complained that the smell was making it hard to breathe and comically making gagging noises.
“Do you have any matches,” I asked the daughter?
We burned a few matches and I had now gone from being the “Angel of Mercy” to near Goddess status as the sulfur dioxide from the matches took over the scenting of the room.
I reviewed the causes of constipation again and her bowel program. Some causes include lack of fluid intake, decrease mobility, lack of fiber, change in routine or diet, too much cheese, stress, some illnesses and some medications. Long term laxative and/or enema use is also associated with decline in intestinal muscles, leading to, constipation.
Some things caregivers can do to prevent constipation include:
- Increase fluid intake including prune juice and a couple of cups of coffee. Note that too much caffeine can dehydrate and milk constipates some people.
- Warm beverages.
- Increase fiber by including a diet rich in whole grains, fruits, vegetables, and legumes.
- Increase exercise. Walking is best but anything helps.
- Use the bathroom when the urge is felt.
- Place a low stool under their feet when toileting to promote comfort.
- Establish a routine toileting time.
- Allow privacy.
- Use a raised toilet seat to make it easier for them to get up and down.
- Treat hemorrhoids.
- Ask them what has worked in the past.
- If a medication is suspected, talk with your physician about alternatives.
- Try to increase the non-saturated fats in the diet. Sometimes a little greasing helps but avoid old remedies such as castor oil and mineral oil.
If these methods do not work, talk to your doctor or home health nurse to help establish a bowel regime and retrain the bowel.
A note about fiber laxatives: if sufficient fluids are not taken, these types of laxatives will cause constipation.