Sue Collins, RN
I am not talking about profanity or slang. I subscribe to several e-newsletters, this week I received two about the subject of poop! Immediately I thought it must be colorectal cancer awareness, which is in March not February. Since neither article mention colorectal awareness month, I chalked it up to coincidence. But it got me thinking about caregivers and the importance of keeping their loved one’s bowels moving on a regular basis. What defines ‘regular’ varies from one person to the next. I have had different friends mention over the years they go once a week. My reaction, after I lift up my lower jaw and close my mouth, is: WHAT? I cannot even imagine. How unhealthy I tell them. Eat more fruits and salad I say. Don’t you realize those are toxins hanging out in your body for a week?
Constipation can create a slew of problems from abdominal distention and pain to rectal pressure, hemorrhoids and vomiting. Decreased activity, appetite, dehydration, sedatives and narcotics may be the cause of constipation. Diseases such as multiple sclerosis, Parkinson’s and stroke can affect the nerves that cause the muscles in the colon to contract. For someone cognitively impaired, lethargy fever, agitation and complaints of headache may indicate constipation or impaction, especially when the symptoms come on suddenly. I have witnessed an immediate change in behavior of someone with Alzheimer’s after stool is removed either manually or with the aid of laxatives or an enema. When my children were young (elementary school age) and they complained of a headache they would always follow up by saying, ‘I pooped today, Mom’ because they knew my next question. It always put a smile on my face because it meant they had listened to what I suggested as a cause of the headache.
Not allowing constipation to get out of control is key. During my nursing career, I have known patients with dementia, who became agitated or combative, end up in the emergency room with a severe bowel impaction. Or patients with complaints of intense abdominal pain and vomiting going to the emergency room to find the symptoms were cause by constipation. Going back to what defines regularity of bowls depends on your loved one’s disease and activity levels. But generally speaking, if the bowels have not moved in two days it is time to look at over the counter stool softeners or laxatives. Avoiding a trip to the emergency room as those described above would obviously be less stressful for both the caregiver and for the loved one. Prunes, prune juice, warm liquids, and fruits may help as well. You may want to consider a potty calendar, because it is easy to forget how many days have passed, since any stool was passed.