My Wife is Back Home After 4 Months in AL while I Recover from Surgery; Constipation

btl1953

I had a Laminectomy at 5 levels of lower spine; surgery went great and cured my nerve pain in my legs but the site got infected. I was on a wound vac for 2 months. While all of this was going on I placed my Wife in Respite Care at a very good facility about 30 minutes from home. My Wife came home Monday (1/31/22) after 4 months in Respite and I started her in the Adult Day Care we used prior to Her Respite but increased from 2 day per week to 4 days.  Prior to her going to Respite I was her 24 hour Caregiver; she needed help with all of her ADLs and was somewhat mobile.  She has come home somewhat more impaired.  She had a mess in her Depends on the afternoon when she came home but has not had a bowel movement since; this is the beginning of day 6 since a bowel movement. I know she has been eating good breakfasts and diners and Day Care  reports she eats about 50% of her lunch and snacks while there.  This is the third day I've given Her Miralax mixed in apple juice and gave her 30 ml of Milk of Magnesia last night to no effect so far.  I've been pushing the fluids but she is hard to get to drink.

The Nurse at the Day Care is aware of  the problem and said I shouldn't let it go past tomorrow; she suggested an enema. My Wife really has a problem with me helping her and I don't relish the idea of trying to give her an enema  (I have never even done that).  Does anyone have any experience with this and do you have any suggestions.  How long have you ever let this go?

Jo C.

I can understand your concern.  Has your wife shown any indication that she is in abdominal pain?  Either way, I would suggest it may be best to contact your wife's physician to see what he/she feels is best under the circumstances as he/she knows your wife's health history and may or may not recommend an enema.  We here do not know your wife's health history and if there are any special circumstances that exist.

There are different types of enemas and you will need to know what kind is recommended for her IF that action is decided upon.  The physician may also recommend giving your wife a daily stool softener gel pill after the enema for awhile until her movements are no longer a problem issue; BUT this should all be done with the physician or nurse practitioner input.

Smaller ready to give enemas are easy to use if the person receiving it is able to cooperate.  If an enema is recommended and you do not feel comfortable with the ability to do it, you can ask the doctor to order Home Health to make a home visit for a physical check of your wife along with an order for the type of enema he wants to have administered IF that is what the physician orders.   The RN can then assess your wife and administer the enema monitoring the results.

Personally, I would not delay; there will be someone on call on weekends that covers for the physician if he/she is not on duty on a Sunday; and if you wait until tomorrow, I suggest callling first thing when the office opens and let the person at the desk know it is URGENT and cannot wait - if an enema is to be ordered and if you will need Home Health to assist, the doctor must order it early enough for them to come out AND PLEASE remind the doctor that he must specifically order them to come out the very same day and not wait 24 hours which they usually do.

It would also be a good idea to find out which Home Health agency will be called if that is the route taken; you can then contact them and double check that they have the order and understand it is a same day visit and approximately what time they will try to make the visit and if they need you to do anything special for their arrival so you can be prepared for them.

It will be easier than it sounds to get done whatever needs to be accomplished.  Let us know how you are doing, we will be thinking of you,

J.  
 

Ed1937

My wife went 6 days without urinating, so I called the urologist. He told me to take her to the hospital. Fortunately before we got out the door, she went. I would think not having a BM would probably be as urgent.

Jo C.

Hi btl; I wonder if you got ahold of the doctor today.  It would be important to not wait longer and one would want to avoid a fecal impaction.  By the way, it can take Miralax anywhere from one to three days to work; so hopefully, being she has had a third dose there will be or have been success.

If the stool is too hard to pass, you will need to contact the doctor or get her to the ER to have her assessed.  Sometimes, if there is a fecal impaction, it will have to be removed manually by a nurse.   One also wants to be cautious regarding any bowel obstruction; if she has any abdominal pain even if it comes and goes; or if she has vomiting or distended abdomen, she will need to be seen right away.  If the constipation becomes chronic, you will need to have that assessed by the doctor; sometimes it is connected to medications or diet or other more complex factors, the doctor will have to assess and make a determination the reason and the best approach.

If you have not contacted the doctor today; if she is still constipated tomorrow, she will need more help asap and may have to see the doctor or be seen in an ER setting; the doctor can be your guide re that; if she develops other troubling symptoms, I would get her to the ER.

J.
 

btl1953

Jo C. wrote:

Hi btl; I wonder if you got ahold of the doctor today.  It would be important to not wait longer and one would want to avoid a fecal impaction.  By the way, it can take Miralax anywhere from one to three days to work; so hopefully, being she has had a third dose there will be or have been success.

If the stool is too hard to pass, you will need to contact the doctor or get her to the ER to have her assessed.  Sometimes, if there is a fecal impaction, it will have to be removed manually by a nurse.   One also wants to be cautious regarding any bowel obstruction; if she has any abdominal pain even if it comes and goes; or if she has vomiting or distended abdomen, she will need to be seen right away.  If the constipation becomes chronic, you will need to have that assessed by the doctor; sometimes it is connected to medications or diet or other more complex factors, the doctor will have to assess and make a determination the reason and the best approach.

If you have not contacted the doctor today; if she is still constipated tomorrow, she will need more help asap and may have to see the doctor or be seen in an ER setting; the doctor can be your guide re that; if she develops other troubling symptoms, I would get her to the ER.

J.
 

J: Thanks so much for the reply. I took your advice to heart and contacted DW's GP and the Physician on call responded (actually it was a CRNP that my wife had seen in the past). She advised it might be best to go to the ER. I called my Son to get him to come help. He arrived in about an hour with his Fiance. I think there visit stimulated my wife after about a 15 minute conversation. I said lets try one more time on the toilet. I left her alone for about 5 minutes and when I returned to check on her she had a major (and I mean major) bowel movement. We were literally almost out the door to the ER.  I am going to start to give her the stool softener that I use and maybe we can get the adjusted to avoid future problems. Thanks again for the reply and follow-up.

Tim

BethL

To treat/prevent constipation:

Fiber

Fluids

Magnesium

Exercise

You can look online to try to ascertain proper amounts, but this is a 4-pronged approach.

Jo C.

I am so glad there was success and what a surprise that must have been.   To ensure that you are using the correct sort of stool softener, you may want to call and ask what is recommended.  Colace is often used, but it is good to have guidance along with the good diet with adequate fiber, water intake, etc. There is much regarding this to be found online at credible sites.

As for giving any supplements, most of them to one degree or another can interact with prescription meds and any med or supplement can cause side effects.   You will want to ask your doctor and also do a little Google search using valid sites to gain information.

So hope all goes well from this point. 

J.