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Apologizing in advance for this topic and the level of detail!


Mom has struggled with constipation for many years. She has managed with Ducolax and a enema bottle device to add water to her dry anus. 1 week ago she fell and broke her leg and is now in skilled nursing. She cannot put any weight on the broken leg and is too weak to support and pivot transfer into the wheel chair to go to the toilet.


Sitting on the toilet is preferred to defecating in her diaper for cleanliness reasons (she has an open bed sore dime size) but also for physical therapy reasons. The more she gets up and moves around the sooner she will be strong enough to go home after her leg heals. She wants to do her routine so she can defecate quickly but cannot do so with her broken leg.


But to get her to the toilet takes 3 people - 2 people to transfer her and one to hold her broken leg off the ground. Very difficult to arrange more than once a day for the staff.


So the first time her nurse did the digital stimulation and then the second time she asked me to do that. I am very grossed out by that especially when she asked me to do it multiple times.


She has been able to defecate a couple of times without stimulation but only a small amount came out and she did not feel relieved. She doesn't want to drink a lot of water because it goes right through her and she would need very frequent diaper changes. She IS drinking water and liquids and is not dehydrated.


Only nurses can do this, no CNAs, right? What can be done to allow her to do this herself? She has to use the potty chair for support which is positioned over the toilet.

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You don't want to go there, real damage can be done by the untrained and/or careless.
My mom's bowel troubles were one of my major stressors, it wasn't uncommon for her to go more than 7 days without any movement. You will get a hundred different recommendations from a hundred different people but for us dulcolax was useless, I had better luck with daily miralax. Bisacodyl suppositories were my dynamite solution to force a movement, they are much easier than an enema. When mom was in the NH they prescribed lactulose.
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JoAnn29 Jun 2019
Yes, surprised they aren't using suppositories. What I read says DS is used on people with spinal cord damage.
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Just read up on it and...I would have told the Nurse, nope, that is her job.
Thats what they are being paid big bucks for.

My problem is with hospitals and rehabs...they think someone should go everyday. Which my Mom didn't. They would use stool softeners, laxatives and in the end Phillips Milk of magnesia did the trick.
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NO, not only nurses can perform digital stimulation. CNAs can do it. My cousin’s girlfriend is a CNA and had to do it to one of her clients. It was one of her job functions. The woman had an injury that prevented her from having bowel movements on her own.
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The NH are doing daily Miralax and were also giving Senecot but mom asked for a substitution for Ducolax since that was her routine. The hospital gave her magnesium citrate but it made her throw up. Suppository also helped in the hospital for a small amount. Perhaps that is the best direction.
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Visited mom on my lunch hour and she's starting the 'want to go home' talk again. They put her on the potty for almost an hour but the CNA refused to do the digital. She went poop just a little. She is miserable unless she has her digital but after she had a good poop from it, she's content and seems to have hope she will get stronger and get out.
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I’d have to look it up but in my opinion CNA’s should not be doing this because of the vaso-vagal response. Only a RN (maybe an LPN too) was permitted to perform this in my clinical hospital days.

Matter of fact, I am not sure that digital manipulation is even done much anymore b/o the vaso-vagal response. It’s frightening what can happen- it happened once to me as a relatively new nurse and scared the crap (no pun intended) out of me. I remember this so clearly as yesterday. The patient was a big guy, I was a strapping 22 y/o 120# newbie. I learned a lesson that day.

And if my memory is correct, it was never done with someone sitting on a toilet. It was done when the person was in bed in a semi Fowler’s position. It’s too dangerous as someone can pass out right there in that tiny hospital bathroom.

I wouldn’t want a CNA doing it. No way.
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Mom wants me to come when they put her on the potty and do the digital for her. I did it once because she was miserable and hadn't had a good poop in days.

If she doesn't get this, its going to be a constant battle every step of the way and a constant brow beating for not taking her home. She needs to be able to be strong enough to do this herself but will they let her?
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Can someone explain to me the dangers of the digital stimulation (other than perforation)? Someone mentioned passing out?
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I think you are mixing apples and oranges - the "I want to go home" talk is common in facilities and if it wasn't the bowel problem it would be something else.

I think your mother has an obsession and you are joining her reality, all you have to do is to read through this forum to hear about people who feel compelled to use the toilet or feel they are constipated even though they aren't. IMO digital stimulation should be the very last option when every other change of diet, laxative or enema has failed. I too was obsessed with my mom's bowel movements (or lack of them) and was certain that they would be the death of her, I was terribly anxious that she would become impacted once she was in the nursing home. She didn't, in fact it was never really a concern for her there. Who knew.
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