CONSTIPATION IN THE ELDERLY Useful Information by Where Is The Care

 

These are possible signs of constipation in general:

  • Large stools.  If stools are wider than 3/4″ or longer than 6″ in general
  • Firm stools.  If like logs and pellets – bad.  If like thin snames or mushy blobs – good.
  • Stool accidents. When rectum is overstuffed/enlarged, stools can just fall out because the rectum is stretched and loses elasticity and sensation.
  • Bedwetting or urine accidents.  A stool mass squashes the bladder.
  • Recurrent Urinary Tract Infections UTI’s.  Bacterica from overflowing stools crawl up the bladder.
  • Infrequent passing of stools.  But daily passing of stools does not rule out constipation.
  • Passing stools twice or more than twice a day.  A streched-out rectum lacks the tone to evacuate fully.
  • Stomach pain. Major reason for this pain.
  • Skid marks on underwear or itchy anus.
  • Super loose stools.  Some waste can ooze by the large, hard, rectal clog
  • Witholding stools. Stool piles up in the rectum, forming a large, hard mass that presses against and irritates the bladder. It’s a vicious cycle: passing stools becomes more painful, so the elderly delay in passing even more.
  • Pain, fever, urinary or fecal incontinence, diarrhea and/or delirium may appear in persons with prolonged constipation (fecal impaction)

 

WHERE IS CARE’S OPINIONs

Constipation is prevalent, in our experience in care homes and hospitals, we were told this time and time again (that is when of course we were actualy told about our own mother’s health and condition or when we had to ask over and over again for information).  We feel many times constipation is happening unnecessarily.  Despite us questioning diets, suggesting additions to diets, suggesting we bring in foods to help naturally, there seems to be little common sense demonstrated or understanding in this area.

When our mother finally came home to live with us (see Abour Us: Our Story) and we looked after her 24/7 wheelchair bound with cognitive impairment on lots of tablets still, we sorted the constipation and she had better bowel health than us almost.  Her constipation was not due to her condition, as we had said to us many times.   Gut instinct tells you this is not right as a family.    But if you disagree does anyone listen?  Not in our experience, the professionals may seem to act many times act as if they know everything, and the family is looked at as interfering, as if they shouldn’t be concerned about what’s happening to their relative and the valuable information that the relative has about the person’s body and “habits” from experience isn’t considered.

 

Just some things to think about from our experiences and thoughts that might help in the care of your elderly care for person.

 

We believe these are the things we feel need to change in care settings:

  • better diets ( and no it doesn’t cost more, just thinking out of the box and organisation )
  • more fibrous diets – bran cereals, broccoli, peas, beans etc.  (check with doctor)
  • more natural ways to deal with constipation not these awful chemical gloopy mixes
  • being more vigilant about residents’ habits
  • better training in understanding what causes constipation, what effects it has on the body,  and what can be done about it.
  • Of course bladders may not empty as efficiently as people get older but holding urine, and not being taken when you wish to go, compounds problems, thickening and further irritating the bladder. Eventually the bladder can get so irritable that it empties without any input from the elderly person.
  • Make sure the elderly are drinking enough or taking in enough fluid.  Check staff know how much one ‘should’ drink a day.
  • Make sure that beverages can be accessed independently, or they are helped regular to drink if not.
  • Better training/education on all areas relating to continence – for example facts such as some elderly people can’t express or feel “thirst” as clearly as when they were younger  (especially true for women with dementia).
  • Use other and inventive ways for fluid to be taken in.  Lollies, cereals with milk, fruit?
  • Training on the correct ways to use laxatives and being more observant – we are aware of some care settings continuing to give laxatives when the person clearly doesn’t need them any more, and is too loose and possibly becoming dehydrated

What we saw:

  • carers telling us it’s okay to put their fingers in elderly folks’ anuses because that’s what they do in their country
  • constipation commonplace – causing enemas to be required
  • elderly folk sitting on toilets for ages – uncomfortable, embarrassed.
  • eldelry folk in pain because they couldn’t go to the toilet
  • eldelry folk left on toilets on their own, unsafe
  • stomach aches
  • totally unsuitable diets
  • lack of knowledge
  • too convenient use of laxatives
  • elderly folks regularly on laxatives
  • elderly folk waiting and waiting to be taken to the toilet

What did we do with mum?

(Always check with GP)

  • Questioned necessity of all medication she had been put on.
  • Liaise with GP to take her off unnecessarily pain control just given as matter of course, because she needs it, she didn’t and this affects bowel movement.
  • Reduced pain control in controlled way with GP’s advice
  • Introduce vitamins
  • Introduce porridge with extra fibre, monitored regularly
  • Introduce fibrous food like prunes, fruit, which she loved
  • Introduce syrup of figs, and considered natural laxatives – monitoring output carefully and adjusting intake
  • Make sure she had enough fluid intake – by using all manner of ways to increase this: custard, lollies etc.
  • Make sure she was eating healthy fruit and vegetables
  • Answer calls of nature when she needed them, she was never doubly incontinent with us although she was labelled such when in care homes and hospitals
  • Use of some simple pelvic floor exercises
  • Improved posture on the toilet/commode

* Please note there is also something called a Squatty Potty to use under the feet when sitting on the toilet to put the you in a more comfortable position to evacuate the bowels, helping ensure more comfortable and quicker elimination. www.squattypotty.co.uk