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Suggest Treatment For Severe Constipation
Question: my husband has Parkinsons and he had a stroke in 2012. He walks with a walker (not easily) and spends most of his time in a wheel chair. We recently moved into assisted living and his diet changed to mechanically soft foods and we have to thicken all of his liquids. After we moved he started having a lot more trouble with his bowels. He was on Hospice at the time and they put him on Senna plus 50 mg. One in the morning and one at night. He usually runs toward constipation but what is going on now is scaring me.
On September 11 the nurse gave him a fleets enema and he had many BM's. One night the aids had to redo his bed 6 times during the night. His bowels kept going and he even had some diarrhea. he had bowel movements on sept 12,13,(no charting)19,20,21,22,. Then everything stopped and he did not have a BM for 6 days. In creased Senna to 2 pills min the morning and two at night. They gave another enema on 9/28 and he had a large results. Then nothing until 10/2 and the Nurse gave him a suppository and he had small results. Another suppository on 10/3 with very small results. On 10/4 the Doctor said to add Muralax once a day. On Oct 7th the Nurse came in at 8am in the morning and gave him another suppository. He had a small result from that. The Doctor said to get 64 oz of fluids in him everyday. We did that Friday and Saturday and he still has had no movement. I am very concerned that he may have a blockage. Am I over reacting or are the people treating him under reacting.
On September 11 the nurse gave him a fleets enema and he had many BM's. One night the aids had to redo his bed 6 times during the night. His bowels kept going and he even had some diarrhea. he had bowel movements on sept 12,13,(no charting)19,20,21,22,. Then everything stopped and he did not have a BM for 6 days. In creased Senna to 2 pills min the morning and two at night. They gave another enema on 9/28 and he had a large results. Then nothing until 10/2 and the Nurse gave him a suppository and he had small results. Another suppository on 10/3 with very small results. On 10/4 the Doctor said to add Muralax once a day. On Oct 7th the Nurse came in at 8am in the morning and gave him another suppository. He had a small result from that. The Doctor said to get 64 oz of fluids in him everyday. We did that Friday and Saturday and he still has had no movement. I am very concerned that he may have a blockage. Am I over reacting or are the people treating him under reacting.
Brief Answer:
Constipation management
Detailed Answer:
Hi XXXX, Thanks for asking from HCM.
I can understand your concern. Your husband is having severe constipation. Your worry is right. He is not getting relief from given medication and enema.
You must ask your doctor to rule out obstruction of intestine or "ileus" by
: Examining his abdomen and listening his bowel sounds
: X ray abdomen erect and supine to find out dilated bowel loops or any free gas
: CT abdomen with contrast - It will rule out any obstruction, cause of it and condition of intestine.
: Also ask him to get ultrasound abdomen and serum electrolytes like sodium, potassium, calcium and chloride done to rule out ileus. In it intestine movement severely decreases.
If everything comes normal, only then treat constipation by
: Increase fluid intake upto 2.5 to 3 litre a day
: Increase fiber diet by adding salad, vegetables and fruits in his diet. Give him fiber or stool softeners
: The doctor can give him motility enhancing drugs
: If still no relief, give enema with proctocalyx or soap water.
I think this approach might help him. Please ask your doctor to rule out any drugs which is causing constipation in him. As antiparkinson drugs can cause constipation.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Constipation management
Detailed Answer:
Hi XXXX, Thanks for asking from HCM.
I can understand your concern. Your husband is having severe constipation. Your worry is right. He is not getting relief from given medication and enema.
You must ask your doctor to rule out obstruction of intestine or "ileus" by
: Examining his abdomen and listening his bowel sounds
: X ray abdomen erect and supine to find out dilated bowel loops or any free gas
: CT abdomen with contrast - It will rule out any obstruction, cause of it and condition of intestine.
: Also ask him to get ultrasound abdomen and serum electrolytes like sodium, potassium, calcium and chloride done to rule out ileus. In it intestine movement severely decreases.
If everything comes normal, only then treat constipation by
: Increase fluid intake upto 2.5 to 3 litre a day
: Increase fiber diet by adding salad, vegetables and fruits in his diet. Give him fiber or stool softeners
: The doctor can give him motility enhancing drugs
: If still no relief, give enema with proctocalyx or soap water.
I think this approach might help him. Please ask your doctor to rule out any drugs which is causing constipation in him. As antiparkinson drugs can cause constipation.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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