She does wear liners in her underpants for urine, but refused pull-ups.
She is now quite inactive, refuses to drink very much in the daytime (so she won't have to get up at night to use the bathroom), and her diet is primarily bland and sweet.
Rice Krispies, cookies and candy, yogurt or 1/4 cup of fruit, and about 3/4 cup of cooked foods. No fiber.
So, significant constipation that she has no awareness of - but caregivers and family have to clean up feces on bathroom surfaces, her hands, her clothes, and try to clear the large amount of solid matter that is clogging the toilet.
I don't want to hurt her feelings (as I can't be sure of my own motives - am I paying her back for her verbal abuse?).
I dont want to blindside her by talking to MD without my mom being aware of the subject. Suggestions?
Before MD visit, I spoke to her about the issue of constipation - she insists not a problem, though it has been for much of her life. She reminded me she is a nurse and would know if she had a problem!!
Then raised the reality about people putting on gloves to manually remove waste and paper from the toilet - she was very embarrassed, of course. Even when her CG who was present confirmed this issue, she refused to believe it. I asked if it is ok for people who care about her to have to do this task - she agreed that it is ok. I know she doesn't really understand. Then she started to cry, and went over to her CG for a hug and reassurance.
The plan for now is prune juice in the morning. Will see if the CG can get her to drink it - found out that she eats and drinks MUCH more for CG than she does for either of her daughters.
I know it is up to my sister and I to ensure her health and safety as much as we can, within limits of her wishes.
After waiting 90 minutes to see her MD (very unusual, apparently) I omitted this issue from the visit - other topics more important. Lacking UTIs or a trip to ER for disimpaction, I don't think I have enough data to make this a priority.
Thanks to all for their suggestions. Will keep in mind as we go along.
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Odd though it seems, some families find it hard to discuss things that seem totally obvious to others. A friend of mine’s grandmother had to be shaved for an operation after she was anesthised, because she had never let anyone see her naked – even her husband! They stripped the necessary bits while covered up in bed!
1/2 cup coffee
1/2 cup prune juice
Warm this concoction in the microwave
Then stir in 60 ml of milk of magnesia.
It tastes surprisingly good, works fast, and is a relief!
Give it a try.
If your mother has 'no awareness of significant constipation' and 'no care about others having to clean up feces on bathroom surfaces, her hands, her clothes, and large amounts of solid matter that is clogging the toilet', I would venture to guess your mother is suffering from one of the dementias which should also be addressed and diagnosed. Once that happens, the doctor can give your family a care plan of action to undertake or a recommendation for placement if s/he feels a team approach is a better idea. You won't be blindsiding your mother if you tell her that it's time for a doctor's visit for a complete and thorough physical. You might even mention that Medicare now requires it on an annual basis, which would be a therapeutic fib to get the ball rolling.
Wishing you the best of luck getting a proper diagnosis for your mother's various issues.
2) Follow her to the bathroom. I had to do this with my dad. Turns out he was rinsing and reusing the TP. The sink was next to the toilet. Not good.
3) make sure she doesn't have to fiddle with buttons or zipper to go to the bathroom. Elastic waist pants helped.
4) colored water...dad liked Gatorade, sugar free. He refused plain water. He also would drink more from a straw. I got him a Teva water glass with a lid and a hole for a bending straw.
5) chia seeds in oatmeal, yogurt, pancakes. Normalizes the consistency of the feces. Dad love his pancakes or waffles with whipped cream, banana and berries. If you get toaster waffles, there are high Fibre ones, I think Kashi makes good ones. You can put grated carrots in spaghetti, don't over do it.
6)sugar free candy, Schiff makes probiotic gummed, Activia sugared yogurt.
Toileting was my least favorite chores. 80% of my mealtimes included toileting, dad..
Also, check into how to find placement for her in skilled nursing. Contact adult aging services in your area. That way you can have options. Medicare and Medicare have procedures for this.
Finally I placed the washable incontinence pads on the bed under the spread. It's easier to toss a pad into the washer than all of the linen. That's helped a little and has made her more aware of the problem without her getting upset with me for even suggesting better hygiene.... I understand your dilemma but we do what we can for the people we love as long as we can.
Praying and Staying Positive.
Sigh. My heart is with you.
Does your mom live alone?
Live with you?
Diagnosed with dementia?
Why is she eating "cookies and candy" and NO FIBER? Who is in charge of her meals / diet?
You MUST tell her sister to see a social worker or medical professional to 'explain' what dementia is and what care is needed NOW. Allowing your mother to have this bowel and feces situations may be considered abuse. She is NOT being cared for as needed.
There comes a time where an adult chid/family member needs to take control as your mother is unable to cognitively, emotionally and psychologically to do so for her well-being.
You write:
"significant constipation that she has no awareness of - but caregivers and family have to clean up feces on bathroom surfaces, her hands, her clothes, and try to clear the large amount of solid matter that is clogging the toilet."
Do you want your mother to live like THIS?
You are concerned about her feelings when feces on her hands ? . . . which will be tracked all over everywhere. She will / may soon have bowel movements in her bed. Then what will you do?
Why are you afraid of your mother and her response to you?
YOU HAVE TO do what is needed for her own benefit. Why wouldn't you want to do this? If you are that wounded / afraid to confront her and do what she needs, someone else needs to 'take charge' and care for her as she needs. Perhaps you cannot psychologically and emotionally manage her care as needed, which seems to be the situation now.
What is the blindsiding about?
She needs professional medical assistance.
Someone needs to be the adult here and she is incapable.
Who is in charge of her well being? You? Another?
Suggestion is that you step up to the plate and put her needs first - and your feelings / fear of her ranting and raving last. She needs care that she cannot provide for herself. This is obvious - isn't it obvious to you?
Gena / Touch Matters
You've given me good strategies to consider, when I see an opportunity to make changes.
I am surprised that she has not yet had a UTI...though when that happens, I will definitely push for changes, if I haven't already been successful.
* You 'push' for changes yesterday, not wait for an UTI or something else to happen to your mother.
* This is no joke.
* How would you or your sister like having their feces on their hands, body, walls, etc - ? Would you (both) want someone there to help you so this doesn't happen / is managed ?
* The caregiver is not giving her 'personal care' - with what you've told us.
* YOU CANNOT WAIT for an opportunity to make changes . . . you have to assert yourself and make them now. What are you waiting for ? besides an UTI to occur?
* While I may sound harsh here, I feel you do not fully understand the seriousness of this situation and how much support / care management your mother needs, which the immediate family is unable to give.
Perhaps it is time to move her to assisted living where she will get more round the clock care.
Its been FIVE YEARS . . . the family cannot handle your mother's needs - which will only increase as time moves on.
Please call social services and get the support / assistance you need.
I feel for your mother.
Gena / Touch Matters
The Caregivers should know what your mom's poop schedule is like every day or every other day, ect.
Et her sir on the toilet a certain time every day or every other day and see if you can have her poop at regular intervals.
Let mom know if she cuts down on water, she could get a UTI and get constipated.
See if mom would wear Adult Pull Ups just at night so she doesn't have to worry about getting up.
Or get her a bed side toilet so she doesn't have far to go.
Cut down on meat and dairy - which are harder to digest, increase with any veggies she likes, and more fresh fruit. Finally a good probiotic at night. You must stress that the caretakers include this protocol if your Mom is in their care for the most part.
A portable bidet such as Luxe, which costs about $45. and is installed under the toilet seat, will help her clean herself without a mess.
Best of luck.
My Mom also needs to be reminded to drink. The thirst mechanism in older adults diminishes. I also provide soups that she likes, to provide nutrition and liquid.
Best wishes.
It really appears your problem is more about her toileting. Here are a few suggestions:
1 - Get a bidet attachment to her toilet. Then, she is getting "cleaned" every time she uses the toilet. Less mess on her hands and transfer to surfaces.
2 - Put her on a toileting schedule. The idea is to encourage her to use the bathroom every 2 hours while she is awake. She should be escorted to the bathroom if she has problems with walking and/or cleaning up afterwards.
3 - Since she has voiding issues, please have her evaluated by a doctor. People should be able to hold their urine at night. If she can't she may have a UTI, a rectocele (hernia of bowel into vagina which is very common), a cystocele (hernia of bladder into vagina which is also rather common), atrophied tissues of the female reproductive tract which may include her urinary tract, or overactive bladder. I am concerned that she might also have diabetes which can cause frequency. Her doctor can prescribe medication and/or treatment based on diagnosis.
4 - Buy some of the pretty "pull-up" undergarments that feel like fabric. There some that are disposable and some that are reusable after laundering. For some people, Depends and the like are admitting that they are old, feeble, need help, "have a problem"... Whatever preserves her dignity will probably be the best way to go.
If you have MPOA or HIPPA clearance and are able to talk to the doctor I don’t think this is a situation where you should be concerned about blindsiding your mom. This is not an uncommon issue for the aging patient and even if medical issues don’t point to the need for the conversation they should be able to bring it up simply saying it’s a conversation they have with all their patients with her issues and living at home…or something that effect. This has become a barrier in your ability to keep her where she is and it’s a big risk for causing other issues, like I said I would expect UTI problem so you really can’t wait for mom to be ready to mention it, it needs to be brought up to her and it needs to be addressed. UTI ‘s can be dangerous themselves but constipation that is causing regular backups in the toilet can indicate or become a blockage in the intestine leading to all kinds of pain and problems like sepsis and surgical intervention. You are helping her not stepping on her toes and having her doctor bring it up may very well be the least embarrassing but more importantly the most effective. This isn’t about her caregivers not having to clean up first and foremost it’s about her health. Good luck!
Prunes help with BMs. It is rich in fiber. So does metamucil every night. But her constipation may get so bad those won't help anymore. When that happens, you need to put your mom on a bowel schedule was every Tues, Thurs, and Sundays. Since mom was insulin-dependent diabetic with chronic kidney disease I could not give her milk of magnesia or any kind of fleets so I got the doc to order her lactulose which worked like magic.
Sugarless candies contain sorbitol which is very similar to lactulose. You can try those and see what happens. Mannitol, xylitol, are other examples of sugarless sweets that can induce loose stool.
I think lactulose, which is prescribed, is easiest, and is covered with insurance. Lactulose will not harm kidneys, and will NOT raise blood sugars.
Those indigestible sugars cannot be digested so they go into the bowel and collect water--and turn the stool soft. I started mom with a teaspoon of lactulose but eventually she needed a tablespoon after a few years. Unlike most laxatives, it is NOT habit forming.
Miralax does something similar but it is costly..if you buy that over the counter.
You should be able to to talk to her doctor and your mom about her bowels. Ignoring it won't make it go away.
When mom was able to walk and go to the bathroom on her own--but could not recall if she had a BM or not, I eventually had to put a lock on the flusher since I needed to see if she went! Her bowels were a very lengthy journey of effort which slowly progressed with her Alzheimer's. She managed to live 90 years, 3 months, after 15 years of Alzheimer's and bedridden the last 3 months of her life because I worked VERY HARD to keep her moving. Inducing bowel movements to a bed ridden person is a nightmare, but I did that. She died not from Alzheimer's but the complications of her many other chronic diseases so if she were a walkie-talkie self caring person the same would have happened. Doctors were surprised she lasted that long but she was FULL TIME care and the moment I woke up to bedtime she requires constant CARE. She died with perfect skin, two years of hospice, she did end up with a feeding tube which is a LOT of care in itself but I never had a single problem with it because i did not want her to die of dehydration which can take weeks. To the end she was comfortable and never require a single narcotic or psychotropic even with the most advanced Alzheimer's.
Since she lives alone, there is no way to help change what she eats. Metamucil would be could to help her bowels but would she be willing to mix and take it.
I know you will say she wants to stay in her home and refuses to move. They all say that. But she doesn’t have the executive function to make rational decisions in her best interest. Either you hire caregivers to help with the cleaning, dosing with Metamucil and get her to drink liquids and eat fruit during the day or you move her to where she can have more eyes on her. It is a sad reality but here you are.
Is her doctor aware of these issues?
Replace mom's underwear with adult incontinence briefs. Accompany her on all trips to the bathroom.
Placing her may be the kindest thing you can do.