The Whitworths of Arizona, bringing science to you in everyday language.

Friday, November 23, 2018

Constipation, Pt. 4: Treatment

In this series of blogs about constipation, we’ve discussed causes, prevention and identifying its presence in someone living with dementia where communication is a problem. This last blog is about treatment. Our friends, Ellen and Ben are back to help us with this.

Once Ellen has indentified that Ben is feeling constipated, she becomes much more diligent about preventative measures, making sure Ben eats lots of fiber, drinks adequate fluids and gets plenty of exercise.

In addition, she increases his preventative laxatives. He normally takes a mild osmotic laxative every other day and a stool softener every other evening. She increases this to once a day for both. Remember, each person is different. Others may need even more, or less. These laxatives are gentle enough that you can experiment with them without much fear of them being harmful. However, they should never be used without consulting the doctor first. The doctor should approve of the dosage change when constipation is suspected as well.

If Ellen catches the constipation early, this may be all she needs to do. However, if she misses the first signs and the bowel may become impacted. That is, the stool hardens and plugs up the bowel so that nothing, or very little can pass. Ben’s body simply can’t function properly when this happens and so it is quite serious, and often extremely painful. Symptoms of impaction are similar to those of constipation only stronger:
  • Severe bloating
  • Abdominal pain, often severe
  • Nausea and vomiting
  • Headaches.
In addition, there may be what seems to be mild diarrhea. Actually, this is the small amount of stool that is seeping out from around the blockage.

Enemas and suppositories can sometimes help, but Ben, like many people living with dementia, can’t hold the enema or the suppository in long enough to do much good. Partly this is due to poor muscle control and partly it is due to his inability to understand why he should do so in the first place.

It is sometimes possible to put on a glove and try to dig out an impaction if it is low in the colon. This requires a knowledgeable “nurse” and a compliant “patient” because the inner tissues of one’s rectum are easily torn. Ellen was once a caregiver in a nursing home and so she knows how to do this and Ben is willing to lie still and let her try this.

If Ellen’s excavation efforts don’t work, her next course of action is to take Ben to the ER, where the nurses are skilled at dealing with this problem and have more resources at hand for doing so than she does at home. In fact, once an impaction is suspected, an immediate ER visit is likely the best course of action for most people. You want this painful, possibly deadly condition dealt with as quickly as possible.

Once the impaction has been broken up and evacuated, expect more diarrhea. This is the stool that has been backed up above the impaction. Once it is out, the bowel can return to normal functioning. That’s when Ellen returns Ben to his preventative dosages of laxatives.

For even more information click here for a very through article by Alzheimer Scotland.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

 Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

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