Expert: Paula Damgaard - 10/4/2008

Question
Dear Paula,
My mum is 82 yrs old and living in nursing home, she would be i think in stage 6 ? she still walks slowly, can sometimes toilet herself, only occasionally feed herself,only speaks her native language now which makes it impossible for her with the nurses, and is very vague and confused especially at night about her surroundings. Even though she is in a nursing home i am her full time carer, i do all the jobs that the nurses don't, due to lack of staff. So i know her inside and out. Her latest problem is that she had a problem regarding urine recently, she was needing to urinate every 30 min in a 24 hour time span, but not little pees large amounts. She would of filled a bucket by the end of the day and from there on her symptoms changed, she went back to urinating every few hours, and the usual amount but she became constipated and had a severely distended abdomen, her back was also severely cramping. I took her to hospital and the scan showed she had faeces in her upper right large bowel. the doctor said to give her 2 sachets of movicol in half a glass of water once a day for 5 days. We are now at the end of the 5 days but her stomach is still distended and hard and still has back pain. She is passing motions but the consistency is different every time she goes. She is still in pain and does not want to eat. I try to get pear juice, water and bran into her but she refuses as her stomach hurts when she eats. I give her panadol and use a heat pack for the pain. Is it normal for her stomach to still be so bloated and hard, and how do you know when she has passed the faeces that were in her upper bowel, what she is passing now are light brown stools so i would guess that it is fresh poo not old, as you would think the old poo would be dark brown in colour. The nurses are no help except for one and she only works occasionally, her usual doctor is away on holidays so i have no one to ask questions to. If you could please shed some light on the problem it would be very much appreciated especially by poor mum. I have 4 children myself and i am finding it harder and harder to find the time for everyone, but i know that due to mum speaking no english  now she needs me there. Look forward to your advice. Her medication list was ridiculous, she was on 30 tablets a day. She refused her tablets so her doctor cut it back down to the bare minimum. She now only takes 5 tablets a day. They are 2 lasix, 1 thyroxine, 1 risperdal, 1 coversyl.

Many thanks,
Tania

Answer
Dear Tania, my guess would be that she is still packed with feces in her bowel.  Even though she is passing some, I think that she is still has some packed in there.  Even when people are impacted, they can still have a movement, but it is only a small amount that is able to slip past the obstruction.  It sounds like she needs an old fashioned enema.  I would ask the doctor if she could still be impacted and if an enema would help to relieve it.  And not a small fleets enema but the old fashioned kind of a bucket of warm water with an added medication that would really clean her out.  

I can imagine she doesn't want to eat, who would?  Once you get her cleaned out then I would make sure that she is on a stool softener and receiving lots of fiber to help keep her regular.  Poor thing, not able to voice her discomfort and being in pain.  

I hope her doctor comes back from his holiday soon so she can get some relief!  

Once she passes all the stool in her bowel her stomach will become nice and soft and flatter, that is how you will know that it is empty.  If you can get a nurse to listen to her belly, I would bet that they wouldn't hear any bowel sounds, another sign that she is impacted.  

I hope this helps.  Let me know how she fairs.  Take care Paula