I only learned a few months ago that she had a rectal prolapse after she started accepting assistance while using the bathroom. I thought it was a new condition so I took her to the doctor. But a family member just told me she had it for at least a decade and probably much longer. For whatever reason, my mother decided not to have it fixed.

It is not causing her pain. But the problem is it makes her think she has to have a bowel movement so she is in the bathroom all the time. She also doesn't have the sense to leave it alone so she is irritating it by constantly wiping it.

A colorectal surgeon has recommended surgery. He says that "down the road" it might become a problem. She might end up in the emergency room and need a colostomy bag.

First, the surgeon was talking about surgery requiring general anesthesia and her being in the hospital for a few days. I expressed concern this would affect her mental functioning negatively. Then he said he could do a smaller procedure which would involve local sedation and at least an overnight stay. Before either procedure, she would require a separate visit for a colonoscopy.

My mom's neurologist has been classifying her dementia as advanced for at least the past 18 months. Physically, she is in good condition. No significant health problems other than blood pressure which is under control. Her weight is good.

Mentally, her condition has declined steadily since her diagnosis. Recently, she has started getting up in the middle of the night, and once tried to leave the house. After months of overeating, we now have to encourage her to eat because she says there is too much food on the plate and she feels full. She needs assistance with bathing and is frequently refusing to shower. Sometimes, she now puts her clothes on in the wrong order. She doesn't know her way around the house she has lived in for over 40 years. She is unable to state her age or how many children she has. She does know when she needs to use the bathroom. She has a history of falling but hasn't fallen in over a year.

Currently, her condition is manageable. She lives at home with full-time assistance. I'm concerned that these procedures are going to totally throw her off course. I will be going back to the surgeon to further discuss potential treatment options.

The surgeon mentioned that if my Mom was 85 and had cancer he wouldn't do the procedure. I'm just struggling with whether to try to treat it or leave it alone.

Just wondering if anybody has experience with this type of situation.


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I agree with answer #1. Is it going to increase her quality of life now or make it worse? It's really not going to help her and will cause immediate problems and may make her worse (I've seen it), then I would not have the surgery. Also going thru the prep work for the colonoscopy may be more than she can tolerate.
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I definitely agree with you jeanne! Remember that surgeons get paid by the amount of surgeries that they are able to perform. Yes, does the surgery benefit outweigh the risks? Only, you along with a trusted provider's guidance can make that decision. But I think, I would think long and hard, because like jeanne mentioned, the risk of "down the road may never happen". I have not had to help make this exact decision for myself or a loved one, but as a professional have had to help many struggle, with these. Sometimes, we feel quilty and perhaps do not make the BEST decision. Many times it is not the difference between a good or bad decision. It is the choice between the better of the 2 evils. SO MANY TIMES WE WANT A BLACK AND WHITE ANSWER, but the answers so many times fall into the gray areas. It is not that we do not want to provide care to those that are more infirm, it just does not usually provide them a better quality of life. In this day and age, it is sometimes more difficult to make these decisions with all the many options available. Many times families do not know the exact procedures involved, and the medical profession does not always hit the mark, in explaining it in a down to earth fashion. So going forward, I think it is all our responsibility- families, medical professionals,and all those in between. First and foremost EDUCATE YOURSELF!, THEN GO A TRUSTED MEDICAL PROFESSIONAL AND IF IN YOUR "GUT" YOU ARE NOT COMFORTABLE WITH THE ANSWER - GO FIND A SECOND OPINION. Remember it is a PATIENT RIGHT. In this case I would say it is the FAMILIES RIGHT.
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I don't speak from experience. Pay more attention to someone who does!

Thinking about the risks here, there are serious risks about having a procedure done, especially under general anesthesia, and in hospitalization for a dementia patient. I think those risks apply now, if you choose to act now, or "down the road" if she needs ER care and need a need a colostomy bag. Since these are both risky situations, I personally would opt for the risk "down the road" -- which might not ever materialize.

From a benefits point of view, what would the benefit of taking action now be? She might not be in the bathroom all the time. She might not wipe at her herself and cause irriation. That is really a good benefit! Is it enough to offset the risk? If she were in the bathroom less but had more hallucinations or less cognitive functioning, would that be a good trade? She would still not know how to put her clothes on she still would fight showers. You would still have eating issues. She would still continue to decline. But maybe she wouldn't feel the need to be in the bathroom so much.

Hmmm ... This is really, really hard, isn't it? I would definitely talk it over with her neurologist. I think he or she could give you more relevant input than the colorectal surgeon can.

Personally, I would not consider the surgery to avoid problems "down the road." I would only consider it in terms of the immediate benefits it might provide. And I'd weigh those benefits against the risks with the input from the neurologist.

I'll be interested in the input you receive here. And I hope you'll share your decision and how it works out. We learn from each other! (And many of us could be facing similar decisions in our own lives.)
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