Brief Answer: Could be fecal impaction with incontinent sphincte Detailed Answer: Hi XXXX. Good evening. I am Dr Shareef answering your query. Most likely your lady is having fecal impaction which is not uncommon in this age group. Due to fecal impaction, the liquid stool above it by pressure leaks from the sides because of the incontinent anal sphincter resulting from the fecal impaction. At times, the hardened stool matters might be coming out as balls as described by you. So this might not be a diarrhea, but passage of liquid stool due to the incontinent sphincter. This problem occurs in old age due to the fact that their diet might not be good enough with roughages and enough liquids, due to which they develop dried up stool in the colon, compounded by the poor abdominal muscle strength at this age, which further makes them unable to increase the intra abdominal pressure to pass the dried up fecal balls. Depression also exaggerates the problem. There is no harm in getting her thyroid status tested in the pathology laboratory in your area. Also I would go for a blood sugar, serum lipid profile, and kidney function tests. The ideal treatment for this would be to supervise and supplement her food with enough roughage and liquids, and if she is having regular bowel movements, then one can think of a suppository, of an enema as a last resort in refractory cases. Also if possible, she should be advised to remain active within her medical limits. The dementia in this lady could be due to very many factors, like the continuing depression, and because of less blood supply to the brain due to the constriction of blood vessels in this age especially in presence of hypertension. As hypertension is already being taken care of as said in the history of the lady, I would advise you to take care of her depression and try to alleviate the factors which are causing it. Usually it is the loneliness and feeling of insecurity at this age, and only her care takers can help in alleviating these problems. This is the best treatment for her along with a healthy diet at this age than any kind of pills. If it is really necessary, you may subject her to a psychiatric consultation to manage her depression. I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. In case of any further doubts, please feel free to ask. Thanks for choosing health care magic for clearing doubts on your health problems. I wish her an early recovery. Dr Shareef.

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