I am feeling at a loss for how to approach a discussion of bowel problems with my mother. Suggestions?

This is why an abused child should not take care of the elder who abused them.

Replace mom's underwear with adult incontinence briefs. Accompany her on all trips to the bathroom.

Placing her may be the kindest thing you can do.

Constipation is either having very hard stool and/or not having a stool at least every 3 days. It appears that her stool is not overly firm if you have to wipe down surfaces. If you are concerned about constipation - given her diet and inactivity - try giving her fiber in gummy form that taste like candy. Start with 1 gummy and increase to 2-3 a day.

It really appears your problem is more about her toileting. Here are a few suggestions:
1 - Get a bidet attachment to her toilet. Then, she is getting "cleaned" every time she uses the toilet. Less mess on her hands and transfer to surfaces.
2 - Put her on a toileting schedule. The idea is to encourage her to use the bathroom every 2 hours while she is awake. She should be escorted to the bathroom if she has problems with walking and/or cleaning up afterwards.
3 - Since she has voiding issues, please have her evaluated by a doctor. People should be able to hold their urine at night. If she can't she may have a UTI, a rectocele (hernia of bowel into vagina which is very common), a cystocele (hernia of bladder into vagina which is also rather common), atrophied tissues of the female reproductive tract which may include her urinary tract, or overactive bladder. I am concerned that she might also have diabetes which can cause frequency. Her doctor can prescribe medication and/or treatment based on diagnosis.
4 - Buy some of the pretty "pull-up" undergarments that feel like fabric. There some that are disposable and some that are reusable after laundering. For some people, Depends and the like are admitting that they are old, feeble, need help, "have a problem"... Whatever preserves her dignity will probably be the best way to go.

According to your profile, you are a "Nurse with long experience in elder care in all settings, aging in place, elder abuse casework, mental health and addiction, and hospice. Turned the caregiving I learned as a child into a career." With your level of experience, what would you tell someone else asking this same question, as a third party, with no relation to the patient who's constipated and in this awful situation?

If your mother has 'no awareness of significant constipation' and 'no care about others having to clean up feces on bathroom surfaces, her hands, her clothes, and large amounts of solid matter that is clogging the toilet', I would venture to guess your mother is suffering from one of the dementias which should also be addressed and diagnosed. Once that happens, the doctor can give your family a care plan of action to undertake or a recommendation for placement if s/he feels a team approach is a better idea. You won't be blindsiding your mother if you tell her that it's time for a doctor's visit for a complete and thorough physical. You might even mention that Medicare now requires it on an annual basis, which would be a therapeutic fib to get the ball rolling.

Wishing you the best of luck getting a proper diagnosis for your mother's various issues.

Since she likes sweets, give her prunes. But soak them in water first to soften them and then cut up them into small pieces to be sure there aren’t any stones inside. Then be ready for the messes when the prunes accomplish their mission.

You have to put her on a bowel schedule. If my mom did not have a bowel movement (BM) in 4 days she would be impacted--the stool got so large and hard it would be like a baseball. It would come down to oil enemas and be a BIG mess.

Prunes help with BMs. It is rich in fiber. So does metamucil every night. But her constipation may get so bad those won't help anymore. When that happens, you need to put your mom on a bowel schedule was every Tues, Thurs, and Sundays. Since mom was insulin-dependent diabetic with chronic kidney disease I could not give her milk of magnesia or any kind of fleets so I got the doc to order her lactulose which worked like magic.

Sugarless candies contain sorbitol which is very similar to lactulose. You can try those and see what happens. Mannitol, xylitol, are other examples of sugarless sweets that can induce loose stool.

I think lactulose, which is prescribed, is easiest, and is covered with insurance. Lactulose will not harm kidneys, and will NOT raise blood sugars.

Those indigestible sugars cannot be digested so they go into the bowel and collect water--and turn the stool soft. I started mom with a teaspoon of lactulose but eventually she needed a tablespoon after a few years. Unlike most laxatives, it is NOT habit forming.

Miralax does something similar but it is costly..if you buy that over the counter.

You should be able to to talk to her doctor and your mom about her bowels. Ignoring it won't make it go away.

When mom was able to walk and go to the bathroom on her own--but could not recall if she had a BM or not, I eventually had to put a lock on the flusher since I needed to see if she went! Her bowels were a very lengthy journey of effort which slowly progressed with her Alzheimer's. She managed to live 90 years, 3 months, after 15 years of Alzheimer's and bedridden the last 3 months of her life because I worked VERY HARD to keep her moving. Inducing bowel movements to a bed ridden person is a nightmare, but I did that. She died not from Alzheimer's but the complications of her many other chronic diseases so if she were a walkie-talkie self caring person the same would have happened. Doctors were surprised she lasted that long but she was FULL TIME care and the moment I woke up to bedtime she requires constant CARE. She died with perfect skin, two years of hospice, she did end up with a feeding tube which is a LOT of care in itself but I never had a single problem with it because i did not want her to die of dehydration which can take weeks. To the end she was comfortable and never require a single narcotic or psychotropic even with the most advanced Alzheimer's.

I do agree that supplimenting her diet with things that may help resolve the constipation problem would help, You may be able to hide prunes in baked goods, Magnesium citrate will loosen things up (check with Dr. First!), but with either, she MUST drink enough fluids (doesn't always have to be water). Try straws in her glasses, it may be the action, not the fluid that is the problem. Also a pretty glass or container gives visual stimulus. I was told when my father had covid, to get him to drink an ounce every 15 minutes. It adds up. Also a portable bidet (water bottle with directional spray you can find on amazon) would help get her cleaner down there when things are "sticky".

I sat down and had a conversation with the people who live in my home that as of last year I am the primary caregiver even though there are 5 other siblings. I care for a 98 year young mother and a 64 year old disabled sister. I explained that cleaning up fecal matter on the toilet, toilet handle and floor is not something I should do with an adult who is capable of taking care of most of her personal hygiene. She denies noticing that she smeared an enormous amount of waste on top of the toilet so I walked her back into the bath room to show her before I cleaned it up, I attend all visits to the doctor and have even scheduled in home visits through her insurance. She lived in her own home up until last year and never left this much of a mess in her house.??? It has not improved but I have addressed it. She dismisses and me. I have a nice home and I'm trying very hard to make it their home as well.......Conversations about cleaning up behind yourself come up a lot. On the water issue.... I asked the doctor to explain the importance of drinking water for better health.... She - also loves sweets. A fresh fruit smoothie contains kale, ginger, carrot juice, bananas, and other frozen and fresh fruit on hand. If I can get her to drink just half of a cup of 8 ounces it helps her digestion. It's understandable that saying somethings might hurt her feelings but fecal waste is bio-hazard. It was difficult to get them to do disposable underwear but I purchased the cute ones in pink, black and purple......... They don't look like diapers they are actually a little sensual. What's on the toilet or her hands can carry to parts of the home where you relax, or even eat,,, Safety First. If they have an accident and she has a couple of times they can now toss it into a red bag and dispose of it. NOT IN MY WASHING MACHINE. Unfortunately My talks have failed and I spend more time cleaning than normal. However, since it's family and I am the primary caregiver for both of them the other option was to get outside help a couple of days a week to help acclimate both them to a healthy way of living without offending or over taxing them,

Finally I placed the washable incontinence pads on the bed under the spread. It's easier to toss a pad into the washer than all of the linen. That's helped a little and has made her more aware of the problem without her getting upset with me for even suggesting better hygiene.... I understand your dilemma but we do what we can for the people we love as long as we can.
Praying and Staying Positive.

Your question was actually about how to approach a discussion with your mother. I’d suggest that you do it in the third person: ‘Many people find that….’. ‘It seems that often people find it hard to avoid messes…..’. ‘Have you ever noticed anything like this?….’ Even if it doesn’t get too detailed, it should make it easier when you have to discuss it with the doctor in her presence.

Odd though it seems, some families find it hard to discuss things that seem totally obvious to others. A friend of mine’s grandmother had to be shaved for an operation after she was anesthised, because she had never let anyone see her naked – even her husband! They stripped the necessary bits while covered up in bed!

Clairesmum: Imho, you must speak up about this issue to your mother's physician or to her, else you face an expensive plumbing bill.

1) take away her underpants and put pull-ups in the place they used to be. You can put liners in them.
2) Follow her to the bathroom. I had to do this with my dad. Turns out he was rinsing and reusing the TP. The sink was next to the toilet. Not good.
3) make sure she doesn't have to fiddle with buttons or zipper to go to the bathroom. Elastic waist pants helped.

4) colored water...dad liked Gatorade, sugar free. He refused plain water. He also would drink more from a straw. I got him a Teva water glass with a lid and a hole for a bending straw.

5) chia seeds in oatmeal, yogurt, pancakes. Normalizes the consistency of the feces. Dad love his pancakes or waffles with whipped cream, banana and berries. If you get toaster waffles, there are high Fibre ones, I think Kashi makes good ones. You can put grated carrots in spaghetti, don't over do it.

6)sugar free candy, Schiff makes probiotic gummed, Activia sugared yogurt.

Toileting was my least favorite chores. 80% of my mealtimes included toileting, dad..

Also, check into how to find placement for her in skilled nursing. Contact adult aging services in your area. That way you can have options. Medicare and Medicare have procedures for this.