Question on bowel movement

[Larrytbm]

Sorry for the title, but my PALS is saying she is having difficulty. This is not a constipation issue, but muscle weakness. Can anyone offer any ideas or suggestions? We are in our RV right now, won't be home for another week and next clinic is not til May. Any help appreciated.

 

[Nikki J]

Make sure she is well hydrated. Try abdominal massage in a circular motion. One of our members said the pressure of a gait belt around her lower abdomen helped. When she is on the toilet put her feet on something so she is in a squatting position.

This unfortunately can be a major issue for PALS

 

[ShiftKicker]

I have experienced this- a combination of low/no gut motility, meds, inability to "bear down" and lack of activity has caused things to come to a screeching halt. All the fiber in the world can't completely resolve the type of constipation that comes from a lack of peristalsis and smooth muscle activity.

So far, the only thing that's been even partially effective for me is an over the counter product called Lactulose. It, in combination with gravity (via a change in posture while on the toilet), has been the only thing that has helped. It does necessitate drinking lots of fluids to make sure dehydration does not set in- but the increased fluid intake could also contribute to getting things going too.

Nikki's recommendation to try to create a squatting position is really helpful- as is making sure your wife is able to sit up as straight as possible instead of hunched over- it lets gravity help things a bit.

I hope this discomfort is not overshadowing your road trip/rv-ing adventure too much. It really is amazing how a lack of a decent bowel movement can start to effect your day to day.

~Fiona

 

[Nikki J]

Lactulose requires a prescription in the US.

 

[ShiftKicker]

Darn, sorry. I had no idea. Canadians can walk into a drugstore and just ask for it. Apologies.

 

[lgelb]

Larry,
Warm or hot liquids, spices/salsa, etc. may soften a bit -- as others have mentioned, fiber and laxatives create more bulk, which creates even greater needs for fluids. I know some PALS here use them, but they are not always the answer. If more fiber is needed, something like canned spinach, where you are adding liquid as well, can be blended for a tube or swallowed.

Also, expect the schedule for what is "regular" to change with this muscle weakness, so the tradition of going every day or whatever isn't what you are aiming at -- it is whatever interval is comfortable and attainable.

Best,
Laurie

 

[wishmobbing]

Hydration really can't be stressed enough, having the feeding tube helped my PALS in this regard. But as others habe said, there's less moving so there's less movement. Movicol/Magrogol is a stool softener that should be sold over the counter and can be taken pre-emptive in the long term and not just in acute situations. I think in hospitals here it's kind of a welcome drink. ;- )

 

[affected]

Yes we used Movicol every day, we never waited to need it.
The only difference was Chris would decide if he felt he needed one or two sachets each day.

Each morning I would give him at least 500ml of liquid in the first 45 mins before he even got out of bed, with his movicol, often it was closer to 700ml.

I do feel that starting his day with a big hydration and the movicol made a big difference here.

 

[tripete]

i am at a point where every three to four days my hospice nurse physically removes it

 

[Narrowminded]

Another product that seems to help Brian is Natural Calm. It is powdered Magnesium Citrate. You mix it with water. They have different flavors. For Brian it goes through the feeding tube. I buy it on Amazon. I caution to start slow. I tried it for the relaxing benefits, and it is sold with that idea hence the name, but 1 tsp was too much for me and created Disaster pants. For Brian though, it keeps him soft. While he can no longer get to a commode, sometimes I and press on his belly a bit and it will come out. However mostly, like Pete I have to go finishing like his nurse. Hope this helps.

 

[KimT]

I've had constipation problems ever since going on Remeron in 2003. Back then I ran 10 miles a day and stayed hydrated but it still wasn't easy to "go." Prior to Remeron I went three times a day like clockwork and never even knew what constipation was. It's horrible. I took fleet enemas 2-3 times a week for 10 years.

Some of the things that help me. First, I'm still able to walk and swallow so some of this won't help you if that's the case.

1. Drink lots of water
2. Eat lots of fruit, especially blueberries (they can be blended in a Vitamix and still have their fiber plus add more liquid)
3. Magnesium. I take 1,200 mg a day (0xide and taurate)
4. Avoid dairy. I try but I still love the Greek Yogurt. When I have Greek Yogurt I load it with ground chia seeds which will provide more fiber. I also add fruit like raspberries, strawberries, and blueberries for more fiber and liquid
5. I bought a foot stool on Amazon. It is designed to be used on the toilet to put you into a squatting position. It works for me.
6. I still use psyllium but would caution against it unless you can swallow easily and drink a lot of water before, with and after taking it. There are brands with no other ingredients and that's what I use. It should NEVER be use with tube feedings as it thickens and expands.
7. I still use an occasional fleet enema, although they have their own issues.
8. Sometimes I massage my own belly in bed before I get up in the morning. This seems to help.

I can't tolerate stimulant laxatives because they aggravate my heart arrhythmia. I've not tried any of the suppositories but there are some that helped my friend who died from pancreatic cancer when she was in bed full time.

I have the added curse of hemorrhoids so I'm now taking a Prep-H before bed and using the cream with cortisone after each successful movement.

I know early on that this would be one of my biggest challenges as I became more and more inactive. I plan on getting the hemorrhoids taken care of (banded off) after my dental work is finished.

 

[bkite]

I was to the point 6 months ago where the effort of transferring to the commode chair and sitting on it tired me so I had no energy for a bowel movement for days at a time. Switched to wearing a depends. With magnesium plus some Miralax, I have regular daily bm's after I lay down for a nap. It is actually easier for my wife to clean me up on the bed than to reach around under the commode seat. The bed is protected by the Tommy Turner mat Joyce uses to roll me over during the night.

 

[Atsugi]

This is my favorite subject.

Sometimes ya just gotta oil up, and go in there and get 'em.

It's really important to keep the exhaust chute clear. Good luck.

 

[wishmobbing]

Haha, Mike, thank you for sharing your fond memories with us! It's posts like these that assure me that I'll not only be able to do all of this if need be but crack a joke about it, too.

 

[KimT]

It someone's going up my butt on a search and seizure mission, I'm sure as heck making these internal hemorrhoids history.