Bathroom Number 2 question

Quilting brings calm

Mom told me something weird today about her bathroom stool habits.  She said that she can no longer push her stool out sitting on the toilet.  Instead she makes sure she has a diaper on and then stands up ( usually in the bedroom) and does  her thing.  She already has issues physically making it to the bathroom in time sometimes to urinate because she uses a walker.  This isn’t some sort of off the wall talk.  She knew what she was saying and she was embarrassed about it. 

I am painfully aware that there are times we need to shift positions to go because the stool just won’t pass.  However I’ve never heard of standing up.  Is this a physical issue of her muscles just not being strong enough ( she does have severe back issues)?  Is this incontinence?  Is this a  move towards the next stage?   

M1

Could be a pelvic floor problem of some sort qbc, like a rectocele-all pretty common in older women who've had children. I wonder if a stool softener like Colace might help. Is she up to date on colonoscopy screening?

Quilting brings calm

M1 

She had a hysterectomy at 40-fibroids and a bladder reissue/ reposition? later on.  She had a GYN appointment a year ago but the doctor didn’t do an internal exam.  

She’s already on a stool softener, but I will inquire as to whether she’s actually taking it. 

She’s 84.  I don’t know when her last colonoscopy was to be honest.  Definitely over 3 years ago since that’s when I took over her medical appointments.  I’m not sure about getting one - actually more concerned about the day/night before rather than the slight amount of sedation used.  But I understand your thought process - read on to the last paragraph for more info. 

In 2021 she was complaining about pain where her gallbladder would be if she had one( she doesn’t).   The doctor did some scans and X-rays and she was sent to a pulmonologist and diagnosed  with NSIP and lung scarring. A breathing test showed she was doing ok, she’s not on oxygen.   She saw her pulmonologist for her annual follow up in October 2022 and got a CT scan today ordered after that appointment. My understanding from the doctor was that it’s just for comparison purposes. The pulmonologist has referred her to a rheumatologist because a specific blood test was high.  That appointment hasn’t come through yet.  

She is complaining of pain back in  that same area the last couple weeks, now that an increased dose of gabapentin is finally helping her neuropathy in her legs and feet.  I thought I’d wait and see what the CT scan showed and then if nothing new shows, call her PCP.   It’s so hard to tell with her - the staff at the assisted living facility told me they all try not to ask her how she is feeling because she always finds something wrong with herself. 

CanyonGal

My mom gets severely constipated. She needs a stool softener and sometimes Miralax daily to promote a bowl movement. Then those medications stopped working and she got backed up to where she was sent to the ER. She was doing the standing thing trying to push the stool out. I thought she just didn’t have the muscle tone to push it out but it was because she was constipated and the stool was impacted.  She needed several enemas to get the stool out. Hospice began giving her lactulose if she hadn’t had a bowel movement in 3 days and that medication makes her go. She gets a bit freaked out when she has a bowel movement.

Quilting brings calm

Canyon Gal - I take her to her psych appointment to get her sertraline refilled tomorrow.  I will ask her about the frequency of  things while I have her in the car.  She hasn’t complained of being constipated for a while, but that doesn’t mean she isn’t. 

M1

qbc, I completely agree that I wouldn't do a colonoscopy now.  This is not likely anything you can fix.  If the positional changes are working, then fine.  But yes I would try to ensure that she is in fact taking the stool softener, as that might help.  It might be worth looking at her other medications regarding constipating effects--I think you mentioned trazodone at one point?  My partner got terribly constipated on it.

Quilting brings calm

Well today was frustrating on this subject and then in general.  

I asked mom if she could be constipated.  She said ‘ well a little’.  So have you been taking your stool softener or laxative?  ‘No.   The laxative makes a mess’.   So take the stool softener and maybe you can sit down  to go.  ‘ I’m not constipated’.   And around we went.   

The psych medication appointment went well.  She saw a new resident as the other one has moved on.  She chattered  like a magpie.   So the sertraline and mirtrazapine are doing their job at the current dosage, and she will finish weaning off the generic Xanax at the end of the month.  Of course we discussed that slight medication tweak 5 times in the office and again in the car.  

Then I got frustrated because I was trying to get her back to the AL in time so she could eat lunch and she wanted me to stop at the store and pick up Depends even though she had plenty at home. I said no.  I had that conversation  multiple times too and I finally snapped at her.  Not a good look on my part.  The store  is a problem because my step-dad doesn’t want me to do it- he wants to do it.  Paranoia about the money.  Yet he really needs to stop doing it as it wears him out.  

I saw the facility nurse and we chatted about both of them and their health.  She will let me know if  she thinks I need to schedule a PCP visit for either of them before their scheduled one in March. Right now she thinks mom is ok and that he is dealing with the natural progression of his  emphysema and the thyroid cancer nodules in his lungs. ( that’s my take on him and  she agreed). 

ninalu

Hi Quilting, 

I don't know if sharing our story / situation will help, but I hope so. My mom has chronic constipation (late stage Alz and Parkinson's) and we have to use multiple layers of meds to ensure that she goes at least every 2-3 days. We use stool softener daily (docusate sodium / colace), miralax several days a week, AND bisacodyl laxative suppositories. We also have to ensure that she gets enough fluids and dietary fiber, which is tough sometimes (I mash up all-bran cereal into cream of wheat and puree whole fruits and veggies, including skins.) AND we have to eliminate caffeine, which according to the doc tends to release fluid from the body and work at cross-purposes.

In our case, mom's autonomic nervous system is not functioning normally to send messages to stimulate sufficient bowel contractions. I don't think she's trying to hold the poop in (which apparently happens to some patients.) For us, it's a work in progress. 

One other thing, our doc mentioned that as long as patients can get upright and move their body somewhat, it helps to support bowel health. This made me think of your description of what your mom said about standing up. Something about gravity and physical activity. My mom is bed bound, but we still move her position as much as we can to stimulate the brain / body. 

I think it's hard - the whole pooping-gone-awry thing. Dignity and privacy and all that. I hope you find a set of solutions that work well for you and mom. 

Mariez

Mr DH was diagnosed officially June 2020 with Alzheimer's but had signs from a CT back in 2017 and has been taking meds for it since that time.   He is about in the middle stage and I'm full time caregiver.  Has trouble getting out of bed and trouble getting up from couch and now is confused how to sit down.  As a result of injured my neck, arms and now middle back helping him and is half his weight.  He gets confused walkng in home and just stops facing a wall or a table etc.  Uses a walker, has diabetes, COPD, and wears Foley/Cathether past two years since bladder not working plus other medical issues.  Can't afford highly skilled medical facility (which he needs because of these medical diagnoses).  Also having difficulty eating ... not wanting it, or confused about how to.  This affects blood sugar levels which I have to adjust but not a nurse so just guess.  Sleeps all day ... 14+  hours and also while eating.  Had consultation with Hospice but too early to stop meds and let nature take its course.  Don't know how to handle my situation and don't have resources for help with him.  Any suggestions would be most welcome.

Linda_Miami

My mom takes Miralax daily.  If for some reason that doesnt work and she hasnt had a bowel movement in 3 days, her hospice nurse told us to give her Milk of Magnesium with or without warm prune juice.