Mom used to be obsessed with having a BM. She took Miralax often. Since she has been receiving palliative care at home (since the beginning of the year), she has been impacted at least 3 times -- twice in the past 2 weeks. The nurse said Mom is very sensitive [to being impacted]. We just had to make note of when she goes.

Hospice put her on Senna Plus (pill form) a while ago, since the Miralax was not working. We tried to regulate the Senna because she was going several times in one day, and most times would not know it (too soft). She was to get 2 Senna/day. When she was too loose, we cut it back to one for a day. Then sometimes we had to give her 3, twice/day. (Max dose is 3, 2/day.)

Though it was hard to regulate, at least she was making an effort to go -- until about a month ago. Since then, she has said she has to go to the bathroom, but if she couldn't get a movement going on the first try, she stops (the nurse even saw that on Friday). I even tried coaching her. It doesn’t register. The more she doesn’t try, the higher chance of her becoming impacted. How can you tell her what she needs to do if she doesn’t understand?

On Friday, I had to call the hospice nurse, since Mom hadn’t gone much at all since Monday. The nurse gave her an enema and took care of as much of the impaction as she could. I gave Mom 3 Senna that night (after dissolving it in water for almost 2 hours!) to try to clean out the rest of the impaction. Nothing. The nurse contacted the doctor, who put her on a liquid form of Senna Plus. It came yesterday. She has had 3 doses so far, but nothing is happening. But, she doesn't even try.

She has been refusing to take any pills, particularly at night, so we resorted to giving her the Senna in the morning. She spits it out.

I have made sure she has had plenty of water to drink. I fix her salads and make sure she eats vegetables. I have also given her plenty of prune juice lately (she can't chew prunes). She is not a yogurt-lover, but I meant to get some to see if that helps. Of course, if there is still part of the impaction there, it may not get it moving anyway… But, since Friday, nothing has happened.

I know the impactions can be very serious. I can’t just take her to the ER without contacting hospice first. I don’t even know if it is serious enough at this point to warrant that, since she is not showing signs of being in pain. But, I have read stories of the elderly going to the ER and end up with a punctured bowel (fatal).

So, I sit here by myself with her and wonder when I should start panicking….

Has anyone been through this? Is her lack of even trying related to cognitive decline??

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After my mother has BM, (and I clean her up with wipes) I use an over -the- toilet bowl basin for my mother. I fill it with warm water and a sudsy blend of perineal wash. The warm water often relaxes her and she “goes again”.
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Thanks, shad, shakingdust, and wally. I figured it must have been part of the decline. :-( The past few days, she has been doing well (relatively speaking). At least she is alert and somewhat lucid at times. She has been wanting to lay in her bed a lot, though. She takes cat naps.

I assume that with the impacted bowel, they die because of the bacteria backing up in the system??

The nurse asked if I felt okay doing a suppository... I dunno... Not that I haven't done it before, but Mom has to be in a certain mood before that happens... I may have to find a time where I can try, though....The last time, she was aware of what was going on with her bowels, and was welcoming the help. Now, not so much... She was crying when the nurse was working on her on Friday... I had to be in the room to hold her hands...

Yeah, c-diff would not be a good thing....

Man, this is so hard, not knowing what to expect and thinking of all the possible outcomes...

P.S., At times like this I think of what a vet said (after our dog was hit by a car and had not had a poo in a while)... He said, "When the train is ready to leave the station, it will...." It always makes me laugh. But, somehow, I don't think that will work in Mom's case...
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my mom had long history of using laxatives. she used to get regular colonoscopies until she was older and the prep was TOO harsh on her system.
once she was placed in AL she wasn't allowed any more "dulcolax etc". sometimes she would go shopping on the bus, and sneak a box of laxatives. when I would find I would toss.
after she broke hip(which got AL started) nurse said a warm prune juice was better than any laxative (which I think my mom was addicted to?)

anyway prior to AL and prior to broke hip.

my mom actually had a bowel blockage that (if I remember correctly) was caused by uterine scar tissue. I guess it somehow grew around her bowels.

sorry not trying to say this happens to any one else.

just that I understand, having a mother who has dementia and has a history of #2 issues.
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To answer your last question yes. Usually when sensation to go to the bathroom goes it is the beginning of the end sadly. The part of the brain that controls the urge to go has been lost.
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