My wife is in late stage dementia, has severe chronic constipation. Have tried softeners, laxatives, enemas, fiber food, and exercise. Any suggestions?

@Friskydogg,

An elderly family member had the same problem for years, and stool softeners just didn’t cut it. Finally a kindly nurse recommended getting a combination stool softener and stimulant laxative. We bought Colace which combines those two actions, and the ongoing problem was solved within a couple of days. The doctors, who we looped in when we had solved the problem, recommended one pill in the morning and one at night on an ongoing basis. For us, the Colace was a Godsend. At our local drugstore there are at least a couple different brands of over-the-counter combination stool softener & stimulant laxative products you can buy. 

For some people, using only a stool softener just means one then has a buildup of soft stool, which is going nowhere. Stimulant laxatives trigger the intestines to contract and push out the stool. 

I do hope this recommendation will help your dear wife (and you!).

Thank you all for the answers and information. Much appreciated.

My mom is severe late-stage dementia too! I buy the Clearlax or Miralax for my mom. It comes in powder form. I mix a capful into her drink twice a day usually one in the morning/afternoon and dinner time. I put it in my mom’s water, cranberry juice, apple juice or whatever she drinks. It is tasteless. Sometimes it takes 48 -72 hours but it works. I have been dealing with constipation with my mom for the last 9 months. The generic brands work just as good. You can order it off Amazon or find it at Walmart, drug stores, and grocery stores too. You are not doing anything wrong it is the dementia.
Once, she has a good bowl movement then you can monitor it and use it when necessary. This last stage is not easy at all! You are a wonderful husband caring for your wife. Stay strong and be sure to take care of yourself too.

If you have tried stool softeners, laxatives and ENEMAS and your wife is still having 'severe constipation', I'd say she has an impacted bowel issue going on. But like cwillie is asking you, what is your definition of 'severe chronic constipation' and is it painful for your wife? She's on hospice and probably getting pain medication, which is known to cause constipation in the first place so............

If your wife is not in pain and you don't want to get her to the ER b/c she's on hospice, I would just continue as you are, giving her the recommended dosages of laxatives, etc., and let nature take its course. I have found milk of magnesia to do the job beautifully and Grandma's suggestion of The Bomb sounds perfect. And I wouldn't worry about 'long term use of laxatives' etc when hospice is on board in this situation.

If your wife is eating a very small volume of food these days, please do not expect her to pass a large amount of stool in the first place.

Best of luck.

First off I want to ask your definition of chronic constipation - is she literally unable to pass very large and dry/hard feces? Because that is a whole different thing than having relatively normal bowel movements that are spaced many days apart, and the treatment will be different. My mom's home care RN was always stressing mom's need to move her bowels more often, ideally every two or at most 3 days, but my mom often did not go for 5, 6 or 7 days - needless to say this made me frantic with worry and I always began "extreme" intervention by day 5, glycerine suppositories moving up to bisacodyl suppositories to accompany her routine oral laxatives (and also every other intervention you may have ever read about on line). My mom always had good bowel sounds and her feces was soft, she just didn't/couldn't expel it so your situation may be different, but..... The weird thing is that once she was settled into the nursing home they must have counted every brown smear as a successful BM because after a very short period of time on lactulose they gradually stopped all forms of laxative, and since she lived there another 18 months she was obviously fine without all the over the top intervention that traumatized both of us while I was her caregiver. This is a long story meant to tell you that healthcare workers don't always understand the issues the frail elderly and their caretakers face, sometimes it's OK to step back a little to look at the wider picture and reevaluate.

Warm prune juice every morning

One of the combinations that Hospice suggested that I use on my Husband was what they called "The Bomb"
1/4 Cup Milk of Magnesia
1/4 Cup Orange juice
1/4 Cup Prune Juice
Warm this to about body temperature.
One of the caregivers that I had tried it to see if it worked. (answer is yes, unfortunately he was in the middle of a class when it kicked in)

I also pureed Papaya and Pineapple and froze it in 1/2 Cup portions I would give that to my Husband.

I occasionally resorted to Magnesium Citrate (at the time about $1.00 at Walmart)

He got Senna daily

He also had a prescription for Lactulose another laxative. He got that daily.

If your wife is on Hospice as the Nurse if she/he has any other suggestions.

Green grapes. Lots of green grapes. They are a natural laxative and are mild enough to minimize cramping. If eating them is a problem, blending and drinking them has the same (if slightly slower activation) result.

A combination of chamomille pills/fibercon tablets/aloe vera juice taken together.

Apple pectin pills and plenty of water.

Check for hypothyroidism. It can be a cause of constant constipation.

Magnesium deficiency -- didn't work for me or anyone I know but Milk of Magnesium (MoM) is a known laxative.

Glucomannan - "Glucomannan is a dietary fiber usually made from the root of the konjac plant. It's historically been used as food and medicine in Asian cultures. Glucomannan might work in the stomach and intestines by absorbing water to form a bulky fiber which treats constipation." - WebMD
________________________
These are from personal experience with all of them and only the MoM doesn't work for me as I avoid laxatives if at all possible because:

"The overuse of laxatives can lead to electrolyte disturbances, dehydration, and mineral deficiencies. Laxative abuse can also cause long-term and potentially permanent damage to the digestive system, including chronic constipation and damage to the nerves and muscles of the colon."

See https://health.cornell.edu/sites/health/files/pdf-library/LaxativeUse.pdf

I would introduce a magnesium supplement. Start with 200mg nightly and increase by 200mg until she moves, then maintain that dose. After about one month, you can try backing off, we don't need as much once we aren't deficient. I was so deficient that I took 2000mg for six months, 1600mg for two years and now take 800mg daily.

Magnesium deficiency is a common cause of constipation, among other things. It is used by our bodies for over 600 functions, it is a vital nutrient.