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??