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My mom is on morphine and hasn't had a bowel movement in a week. She is in pain trying to go. The doctor prescribed Colace on Monday and she's been on it for 2 days. The nurse in the memory care gave her a suppository on Saturday and one today. After about 30 min she was ready to go but only a small amount (I know TMI). She cries out in pain when she is trying to go. Well, long story short and this is where I need your advice/experience - when I went to wipe it feels like a huge ball (like the size of a lemon) is there. How is she going to get that out?? I hate seeing her in pain. What should I do?

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The nurses used to be able to manually remove the hard stool, but that is frowned upon now. So I would suggest a FLEETS ENEMA. It is a solution in a pint size bottle. That might give some of the lubrication that your Mom needs. Have the nurse give the Fleets Enema to your Mom while she is lying in bed on her LEFT side. Talk to the nurse at the Memory Care Unit and ask what the facility's policy is for treatment of an fecal (stool) impaction.
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The lay person's answer:

Apply Vaseline just before she eliminates. Give coffee just before.
Support the surrounding tissue on the painful side with some tissue/gloved hand.
Cwillie had once suggested wiggling back and forth while sitting on the toilet, but I'm not sure if it was advice for urine or a b.m.

Can she do this by herself without hurting herself?  The nurses should be doing this.

Try not to irritate the delicate tissues. Does she have hemorrhoids? Gently clean and pat dry the area. Apply a hemorrhoid preparation to decrease the irritation and pain .

Take 2-4 prunes daily from now on.
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She does rock back and forth on the toilet crying that it won't come out. The nurse used some vaseline to help get some out. I just wonder how long she can go without going to the ER or if hospice will even want her to go. It's a scary situation for me.
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Use more Vaseline, have the nurse repeat the procedure.
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swright2,
I went through this with my Mother too and what worked for us was first I'd give her a mineral oil enema and if that didn't work,I'd give her a saline enema.The doctor prescribed Miralax which I gave her I believe 17 grams a night she'd chug down mixed with a small amount of water every single night and every single morning,first thing I'd put in a suppository,It was a project and it took some time to get Mom working better in that area,but we figured out what would help her and I let Mom have all the time she needed in the bathroom every morning.She also took a small dose of Senna,but the Colace didn't work for her and she took the Senna everynight too.
I think the Vaseline idea is probably a good idea too.
I'm really sorry you are dealing with this.I feel bad for you and your Mother.Hopefully,you'll find your recipe that works for you all too.Take care~
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I know that high doses of magnesium will help with narcotic caused constipation. Give her like 2000mg a day until she has a BM, then back it off 200mg a day until you find the proper mg without having loose stool. Magnesium will help her relax, so I recommend it be given at night with at least 8oz of water. It can cause stomach upset without enough water.

I hope this helps the 1st night, if not by the 2nd night, she has an impaction and should go to the ER.

Vaseline or castor oil will help with pain and clean up :-)
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I would try the enema first.  If that doesn't work, maybe try glycerin suppositories.  Apply Vaseline first to lubricate.

If those don't work, you may have to take her to the ER so they can manually remove it.

Hugs, I hope your poor mom gets things moving better.  I know it is miserable :(
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I took my aunt (91) to the ER because her aide said her breath smelled like poop. She was not eating, but not losing weight, staying in bed, nausea and her bp was elevated. When I heard about the breath I took her to the ER. They X-rayed her after figuring out she wasnt having a stroke. Her bp was extremely elevated by this time.
She was impacted. They told me to take her home and give her a fleet enema. I called her HH nurse and they came the next morning, gave her the enema and she felt better. Lost several pounds. By afternoon she felt bad again. The next morning she felt really bad. I took her to a second ER. Another X-ray. Still impacted. They recommended miralax and to see a gastro specialist. Said it would take a little time. Turned out it was her thyroid causing the problem. Too much medication onboard. He advised she take miralax everyday. She does. (polyethylene glycol 350 through pharmacy. Ask dr for script)
Along with a probiotic daily with her breakfast. She has not had another problem with her bowels since starting the miralax and getting the thyroid levels corrected. The dr said no stool softener.
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Just a cautionary note -

I would be very careful about loading your mother up with things like Miralax, coffee, laxative type pills and/or potions.

Why? If there is a significant impact type situation increasing the need to go by stimulating, irritating the bowels - it can put too much pressure on the lower intestine prior to the blockage and cause a tear or even a rupture. Think along the line of what happens when you continue to flush a toilet that is already plugged up... sorry, not a pretty visual or comparison, I know.

The enema suggestions are good - but not too many as at some point that liquid too causes a build-up situation if nothing is coming out - and if the intestines are beginning to shut down nothing will be absorbed by the body - you’ll just have a huge internal puddle causing more pain and discomfort.

Talk to the hospice folk. What do they intend to do to help? This happened to my dad once towards the very end - he wanted to use the toilet but was to weak to apply any “push”. Could that be an issue with your mom? With my dad - since it was weakness over impact the TRAINED nurse was able to help with gloved finger tips and lotion. Kids - do not try this at home!!! If you don’t know what you’re doing you can make things worse- a lot worse.

Anyhoo - if it were me, I think I’d be asking for an X-ray long about now - or an ultrasound. Either should be able to identify if impacted stool is the issue.
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My Mom has a history with Constipation and believe me we've tried everything. Lately its been 30cc of Milk of Mag.( no cramps ) and a glycerine suppository the same morning. Sometimes you have to give the Milk of Mag the night before too. Increase fluids and fiber, Stool softeners help too
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Swright, call your hospice team about this and don't take your teeth out of their calves until it's sorted. It is *not* acceptable for your mother to have been allowed to reach this point - it is causing her physical discomfort as well as a certain amount of anguish; and given the morphine px the result was entirely predictable. The morphine should have been accompanied by something like lactulose (or whatever) to prevent the problem. If I were you I'd be livid.

But never mind being livid, be polite but also be persistent and unapologetic until someone gets their ass over to the house and, um, gets things moving. Poor mother! :(
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Your mother is in a memory care? This should be their problem to deal with (or the hospice nurse), and they should have the expertise to do it!

I second (third) the fleet enema, I had difficulty administering these until our nurse demonstrated how to do it, so don't let them push the task on to you. Then, only after it has worked!, you can look at her daily laxative variety and dosages.
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Call the hospice nurses! This is an important part of comfort care.
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My mom used to have chronic constipation but she was unable to tell me because of her Alzheimer's. Since she was so uncomfortable she would wander around which made her high, high risk for falling.   Be careful using Fleet enema or Milk of Magnesia (MOM) if they have kidney disease; phosphate-based laxatives can do more kidney damage (you have to have healthy kidneys to take this), and MOM can cause magnesium toxicity. I do my best to preserve her kidneys because she is not a candidate for dialysis.  Go to your doctor and get lactulose -- which is basically an indigestible sugar and goes to the bowels, collects water and the bowel will loosen. Kidney disease often accompanies constipation. I put a lock on my flush toilet so my mom won't be able to flush and I document on the calendar when she has a bowel movement. They can get impacted as little as three days, but also know the normal pattern of bowel movement. Some people normally go every few days and have done so all their life.  Since my mom has end-stage Alzheimer's with advancing kidney disease I give her lactulose daily, but not 15 ml as directed--only 5 ml daily is all she needs and she goes everyday like clockwork. One large stool a day. It's the best stuff in the world!
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Lactulose is what they use at mom's nursing home cetude, it is probably the only thing we never tried at home. Chronic constipation can be so challenging, I hope swright2's mom has gotten some relief by now.
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i always rely on mineral oil give her 4 table spoon's of it you also need to make sure she drink a lot of water ..if you can get it called linzess so if you can get it do what they say if she need so go real bad but not moving .give lenzess & 2 table spoon of oil with in the hour make sure to get her on the toilet in 4 hours ..my mom was alway constipated a lot linzess & mineral oil = a atomic bomb for bowels ..i know i did it sometimes even the colace & mineral oil together can work to just 1 pill & 2 to 4 tablespoons //it will work ..make sure she drinks a lot of water ..good luck ..is she on hospce care //?? you could also do a colonsocpy to get her ready for it but she will not need to a doctor could tell you what to get that will get her going to just ask a doc ..let me tell you my mom i give her linzess & the mineral oil it will break up what she has in her to the runs ..so that is why need to make sure she is on the toilet in time & it will be a lot... so good luck
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Victory! The ball was born yesterday! The nurse dug a little out and the rest followed.
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I've personally had the problem of too large or hard of stool to be able to eliminate it. The rocking back and forth sometimes help, but I've had to manually remove it myself. I use a glove while on the toilet. For someone who is disabled, I don't know if they could do this. There is a drink you can buy that one of my doctor's called, "liquid dynamite" - it is magnesium citrate and you can get it at the drug store. I have used it and it definitely works. Think of the stuff you drink for a colonoscopy. Kind of works the same way.
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We took my mom to ER and they found she had a twisted bowel and it was closed so nothing could pass. They did a procedure to blow it open. Now we are on strict orders if one day passes and no bm to up the laxative (senna) to
get production. It must not be allowed to close shut again. Drinking water
seems to be an important ingredient. We were doing miralax but it caused too loose stool, so we switched to senna. Finding the right combination is the challenge. One time I gave her a foot massage and that got a production. I
applied a series of 3 impressions at each point on the ball of the foot from the
big toe to the little toe and continuing on down that side of the foot to the heel.
I do not always get results but a foot reflexologist should be able to do it. We have had to resort to an enema. This is a very serious thing. A perforated bowel is not what you want to risk. If they can get up and walk, walk as much as possible. Any kind of exercise would be good unless there is more to the story and that would compromise the situation.
Am praying you find the right answer.
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When my Husband was on Hospice one of the remedies suggested was.."The Bomb"
1/4 Cup prune juice
1/4 Cup Milk of Magnesia
1/4 Cup Orange Juice
Heat this gently until it is about body temperature then drink.
(I tasted a bit it really does not taste as bad as it all sounds)

One of the prescriptions I did end up getting, through the VA, was Lactulose it is a more gentle product on the kidneys than something like Magnesium Citrate. Magnesium Citrate works great, works fast pretty much like the product you take to prep for a colonoscopy. You can get Magnesium Citrate at any store, I got mine at Walmart, think it was less than $1.00 a bottle and there are flavors now not just lemon.

Is she being given a stool softener daily?
One of the products I used to give my Husband was Smooth Move Tea that is Senna based so it also is gentle.

I looked up some of the "cleanses" that are sold over the counter and most contained Pineapple and Papaya so I purchased a pineapple and a papaya and pureed them and froze them in 1/2 Cup portions and I would give him one of those if I though we were going to need a little help.

Side question for you..Is your Mom on Hospice? If so there should be a nurse assigned to her and the nurse should be consulted, they can aid in a fecal impaction.
If she is not on Hospice the nurse at the facility should be doing more they can manually aid in an impaction.
The last resort would be a surgical intervention and that should be avoided at all costs as it is possible that your Mom may not survive the surgery or the recovery process.
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I would go to the hospital. It probably needs to be dug out. The longer you wait the worse it's going to get. Also, give her Miralax daily until she starts to become regular, then if she starts to get to loose stools change to every other day. It had really helped my mom.
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Thankful the situation is resolved! That can be scary.

I wanted to share what had worked with my mom EVERY time, as last resort.

Sauer Kraut Juice.
Yep. Warm it a little and drink. This had NEVER failed us.
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truthbetold Sep 2018
Hi, Can you please explain why it works ? Or theoretically? If it is too sour for some elders with ALz or dementia, can it be diluted in any way or will it lose its effectiveness.
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Everytime Mom was in the hospital, if she didn't go everyday they started her on Senna and Colace. They never worked. My daughter says Senna is a bulk laxative, whatever that means. Milk of Magnesia was the only thing that worked. Mom was on iron which causes constipation. So that didn't help. I agree with one of the post, don't do anything without talking to the dr. Miralax was too much for Mom. I think the ER is needed at this point.
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Don't think Mom should be on Senna. In reading this, it will make her worse. I think the ER would be the best thing.

"Bulk-formers—Bulk-forming laxatives are not digested but absorb liquid in the intestines and swell to form a soft, bulky stool. The bowel is then stimulated normally by the presence of the bulky mass. Some bulk-forming laxatives, like psyllium and polycarbophil, may be prescribed by your doctor to treat diarrhea."
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I had a similar problem. Not as bad. Mom passed very hard lemon like stool, glove assisted. After, alot of waste matter and blood. Everyday in a small juice glass I give my mom aloe vera juice with the chunks in it and a tablespoon of olive oil. It comes in many flavors. It's kept this impacted stool at Bay.
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FYI - Miralax has an ingredient that is part drain cleaner!

I use Traditional Medicinal "Smooth Move" tea (health food store) for my dad. Even for the challenging BMs.

All the best!!
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Give milk of magnesia or senekot ....& enema
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My husbands doctor prescribed a bottle of magnesium sulfate which resulted in a bowel movement which also gave him diarrhea and now I do use it if necessary but only a half bottle. Works great. We were also in the ER on a unrelated problem but there was a man who came in who hadn't gone for 2 weeks and the hospital took care of it. This also might be an option.
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If she can get on the toilet, elevate her feet with a box or stool. That should help a bit. I have prayed for her.
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I literally keep a log of Moms bowel movements for about a year now. Now, that she is bedridden she tends to have more problems with constipation. Long story short, she gets MIRALAX every day in morning. If by day 3 she hasn't gone then we give her M.O.M.
If no movement, then on day for another dose of Milk of Magnesia . Day 5, I set up everything, KY gel, a box of gloves, lots of chucks, to physically disempact her. Thr aide helps by holdong her and lubricating the glove. I only go in woth the glove one time and then throw it out and put on another one. I am extremely gentle with her. When Mom was hospitalised,at one time for something else, she got disempacted. The doctors tried everything but nothing worked. They were going to disempact her but I would not let them because it would've been too much for her. So they "let me do it and assisted me".
After I clean the canal somewhat , I give her an enema. Wait about 15 minutes and put her on the porto-potty. At that point every thing comes "down " with the help of gravity. It takes a tender touch and a big heart. If you cannot do it for her, seek out someone (nurse) that can.
PS: Guess I meant short story LONG..LOL
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