Advice for bowel dysmotility (long-shot, I know)?
September 17, 2021 7:22 AM   Subscribe

Asking this on behalf of my dad, who is in his 70s, and who hasn't managed to have a bowel movement in 27 days despite taking laxatives daily. He got a diagnosis of dysmotility, and is on the waiting list to see a neurogastroenterolgist, but that will likely not happen until next month, hence this long-shot question. More below the fold.

He's already had an MRI and Xrays, and there is no blockage that can explain this. Luckily, he feels okay - no bloating or anything. He's been eating a lot of fiber, but that hasn't made any difference.

He's in average health as people go in their 70s, though he has been struggling with the aftermath of a hip replacement over the last 9 months - walking is still painful for him, and he's become slightly hunched over since then. But he still exercises by doing laps at the local YMCA. Otherwise his health is fine.

Anyhow, just seeing if anyone has dealt with this and has any advice while he waits to see a specialist. He's open to any suggestions. Thanks.
posted by coffeecat to Health & Fitness (26 answers total) 5 users marked this as a favorite
You don't mention his pain medication regimen, but if he is taking something like oxy in order to manage his pain post hip surgery, that can cause major constipation. It may be related to that?
posted by pazazygeek at 7:28 AM on September 17, 2021 [2 favorites]

Response by poster: Not to thread-sit, but no, he's not taking any pain medication. He does get occasional shots of steroids/cortisone in his lower lumbar for pain management.
posted by coffeecat at 7:45 AM on September 17, 2021

With a recent hip replacement, squatting may not be a safe option, and my answer involves squatting, so please consider the safety or lack thereof of this idea.

My dad had a similar problem when on steroids for cancer. He got into a routine of having coffee with cinnamon added to the grounds before brewing, and then he would squat for a couple of minutes in the bathroom. This was very effective for him.

I know this is weird and anecdotal and specific to one person's experience. I hope you are able to find something helpful, that brings your dad relief.
posted by happy_cat at 8:13 AM on September 17, 2021 [1 favorite]

What laxatives? Maybe a different sort might help?
posted by Ftsqg at 8:25 AM on September 17, 2021 [3 favorites]

I suffered recently from pretty bad constipation, and what finally cleared it up for me was a combination of drinking warm prune juice and about a half- hour of self-massage.
I used this method, and it really helped!
Best of luck. 27 days is too long!
posted by dbmcd at 8:47 AM on September 17, 2021 [4 favorites]

If he's eating a lot of fiber, he needs to make sure he's drinking lots and lots and lots of extra water, too.
posted by aniola at 10:10 AM on September 17, 2021 [9 favorites]

Squatting on the toilet with good posture also helps, if he can do so safely.
posted by aniola at 10:12 AM on September 17, 2021 [1 favorite]

When this happened to my daughter we used an over the counter suppository in one instance and in another an enema solved the problem. In both instances, once she was able to have a bowel movement all of the fiber etc. that we had been feeding her seem to get things back to normal, but she definitely needed help with that first poop. Good luck! This stuff is no fun.
posted by jeszac at 10:22 AM on September 17, 2021 [2 favorites]

Safer and easier than squatting is just having a stool of some kind in front of the toilet and putting your feet on it so that your knees are higher than your hips (or at the very least, higher than they would be if your feet were on the ground). Supposedly having your knees higher than your hips relaxes one of the sphincters that helps keep our bowel movements in: In a regular sitting position you’re having to push up and over the ring of muscle but this helps it relax so it’s all a bit easier.

You can google Squatty Potty if you want one designed specially for the job (and more reading as to why it’s a good idea), but just a regular stool would also help.

Probably not going to solve things on its own but might help in combination with other things.
posted by penguin pie at 11:38 AM on September 17, 2021 [2 favorites]

Best answer: There are a few different over the counter laxatives that work in different ways, it may be worth trying multiple. A suggested approach from the NHS national prescribing centre is as follows:
  • Start treatment with a bulk-forming laxative (adequate fluid intake is important)

  • If stools remain hard, add or switch to an osmotic laxative

  • If stools are soft but difficult to pass or if emptying is inadequate, add a stimulant laxative

  • Bulk-forming laxatives are things like fybogel, osmotic laxatives include include lactulose, stimulant laxatives include bisacodyl and senna. Definitely need to drink the recommended 2 litres of water per day if you are using some of these otherwise they don't work effectively.

    As well as thinking about positioning as others have mentioned, given the tentative diagnosis of dysmotility, massaging the abdomen in a specific pattern may help. This leaflet explains how to do it.
    posted by plonkee at 11:45 AM on September 17, 2021 [5 favorites]

    Crank up his fluid intake, like really crank it up, older people should be drinking around 1.7l of water/fluid a day or about a cup every hour to an hour and a half he's awake. Older people are super prone to dehydration which is one of the most common causes of constipation. The urge to drink lessens and their bodies reserves drop, throw in getting up to get a drink probably hurts him if he's still having hip pain and I'll bet he's not drinking near enough. Get him a nice water bottle he can easily hold and use and stock him up with drinks he likes, if you live with him keep it topped up and have it by him all the time. Make him lots of high liquid meals like soups etc. Electrolyte imbalance can play a part too so maybe consider adding an electrolyte supplement to one of his drinks each day.
    posted by wwax at 12:06 PM on September 17, 2021 [3 favorites]

    Response by poster: Thanks to all of the suggestions so far, I've been passing this info on to him and my mom as it comes. There is a good chance he is not getting enough liquid (for whatever reason, he "hates" water). He said he'll try the abdominal massage, though unfortunately he hasn't been able to squat since his hip replacement.
    posted by coffeecat at 1:35 PM on September 17, 2021

    My grandmom's doctor literally had to prescribe her to drink water.
    posted by aniola at 1:37 PM on September 17, 2021 [3 favorites]

    On second thought, I doubt if it was a literal prescription, but the only reason she started drinking water was her doctor gave her a very stern talking to about drinking two bottles of water every day.
    posted by aniola at 1:39 PM on September 17, 2021 [1 favorite]

    I've been managing this issue with my cat for about 5 years - seems silly to relate it to a person. But.

    Had my own experience when an operation stopped things up. Mirulax + huge cups of hot coffee got me going again with the assistance of the box I brought into the bathroom to prop my feet up on.
    This really made me appreciate the pain the cat must go thru when his issue flares. (down from every 7-10 days to once or thrice a year. )

    Based on my experience with the cat - add mirulax & enulose/lactulose. These will soften any hardened stool and keep it soft. With enough enulose, diarrhea may be the result. Messy. But sometimes necessary.

    Tor was initially prescribed a high fiber diet - then high fiber + mirulax. While he was on high fiber, he was also at the vet every 7-10 days. So that factor was changed.
    For the past 4 years or so, he's been on a very low fiber diet - everything that he eats is sprinkled with mirulax.
    When he has flares, I add enulose/lactulose and as rarely as possible - a convulsant - cisapride (banned for humans).
    Luckily, he drinks a lot on his own - adding fluids is also very key.

    posted by gardenkatz at 1:59 PM on September 17, 2021 [1 favorite]

    If he doesn't liike water, any liquid will do. Tea, coffee, soda, juice, milkshakes, soup. Water might be optimal but not if he won't drink it (I find it hard to drink 2 litres of plain water a day, but with flavouring it is easy.)

    Some laxatives work by drawing water from the body and if there's not enough then they can't do their job properly.

    The other tip for timing is to have a hot drink or meal, wait 30 minutes, and take a fast acting laxative (eg magic bullets). The hot drink/food helps to stimulate peristalsis in the gut.
    posted by plonkee at 2:51 PM on September 17, 2021 [1 favorite]

    he "hates" water

    Water is why they invented chugging. I learned it from my other grandma.
    posted by aniola at 2:57 PM on September 17, 2021 [2 favorites]

    Longtime constipation sufferer here. Fiber I can't tolerate very well, only a small amount (two tablespoons max) a day of oat bran in yoghurt. Lactulose was effective but gave me huge bloating and cramps. I've found the best solution for me is Vitamin C in higher doses than usual, and magnesium.

    You can get a 1000mg tablet of vitamin C and take two of those at once first thing in the morning with lots of water, and if that's not enough repeat later in the day on an empty stomach. Magnesium is usually 400mg a day, I've taken twice that amount in a day without having side effects. Also things improved when I reduced carb intake, and started doing lots more walking. And upped my water intake.

    Good luck! 27 days is a long time, he's lucky not to have any major bloating or discomfort.
    posted by bitteschoen at 4:27 PM on September 17, 2021 [1 favorite]

    27 days?!!! That is a long time to have not evacuated one's bowels, long enough that I would suggest he consult his doctor as soon as possible. As the stool remains in the bowel, the bowel continues to remove water from the stool, one of the major functions of the bowel. As the stool gets harder and drier it's less possible for a person to evacuate it, especially if it is higher up in the bowel, meaning closer to where the small bowel (which processes food and removes nutrients) empties into the large bowel, which as I've said removes water and propels the stool (with normal motility) toward the rectum/anus for evacuation.

    In nursing homes residents are often on quite aggressive bowel programs and if they haven't passed stool in 3 or 4 days are given, with physician orders, quite aggressive laxatives, because residents at all costs want to avoid a trip to the Emergency department because they are impacted with a bowel blockage. I would be very hesitant to give your dad aggressive laxatives without competent medical intervention, like at a hospital that can xray his abdomen for obstruction, because all this backed up stool could easily now be a bowel blockage too large and compacted for evacuation. Extra pressure on the bowel (laxatives) can be very painful and ineffective in moving that blockage. Surgery is sometimes needed and this level of constipation with bowel blockage might possibly be life-threatening. This is not a case of keeping things moving with regular fluids, fiber, and exercise, which is preventative. 27 days - nearly a month -without a good bowel movement is seriously problematic and needs professional medical evaluation.
    posted by citygirl at 7:32 PM on September 17, 2021 [11 favorites]

    As far as fluids go, I drink Pedialyte Advanced Care+. It has prebiotics that get me going every time. If I’m really stopped up I drink 2 bottles in rapid succession on an empty stomach and I’m going within a few minutes. Trying this along with the other laxatives might get him going.

    Also, he should be taking daily probiotics and I hope he’s tried Fleets enemas and Dulcolax suppositories.
    posted by 2CatsInTheYard at 10:00 PM on September 17, 2021 [1 favorite]

    I second citygirl’s advice. He doesn’t need to wait for the neurogastroenterologist. He’s in dangerous territory and needs immediate attention. I don’t understand why his GP is not addressing the situation.
    posted by 2CatsInTheYard at 10:10 PM on September 17, 2021 [1 favorite]

    Response by poster: As for the doctor issue - his GP referred him to a GI doctor, who just told him there is no cure and to just take laxatives and eat fiber. Then he found the specialist, but couldn't get an appointment until end of October, but was told if the GI doctor would call the specialist and explain the urgency, he might get a sooner appointment - but the GI doctor said he was "too busy" to do this. So hence I've turned to Metafilter. Ah, the American healthcare system at its finest.

    Anyhow, thanks again for all of these answers!
    posted by coffeecat at 7:47 AM on September 18, 2021

    Does the GI doc understand that this patient hasn't moved his bowels in 27 days?
    posted by citygirl at 7:59 AM on September 18, 2021 [1 favorite]

    Response by poster: Yes, he does - my dad pressed him, and the best he would concede to is that my dad could forward him the doctor's number but he wouldn't promise he'd do anything with it. Anyhow, I've passed this info on to my parents and my dad assured me he'd go back the ER to get another Xray on Monday (the GI doctor told him this is apparently the only way to get one). His last Xray was 2 weeks ago. Thanks again.
    posted by coffeecat at 9:45 AM on September 18, 2021

    Response by poster: Posting one more time in case someone comes across this in the future with the same problem.

    Dad texted me today to say that there has been notable progress (I'll spare you the details)! The only thing that has changed so far was he started to do the massage recommended here, so I've marked that as the best answer, but thanks to all who responded. He has also ordered the Pedialyte Advanced Care+ and will be getting an Xray Monday regardless to be safe.
    posted by coffeecat at 3:11 PM on September 18, 2021 [4 favorites]

    It sounds like things are improving, but has your father spoken to his GP again? Because it sounds like this GI doc is really unhelpful and not taking things seriously. Maybe the GP would be more willing to call the neuroGI to try to get your dad in sooner?

    Either way, getting the Xray sounds like a good plan and being assessed by someone is a good plan, although it seems strange that ER is the only way to do this.

    Also just want to echo to be really careful with stimulant laxatives. They aren't kidding when they say it can be incredibly painful if the constipation is severe. Like really really painful. I'll spare you the details on how I know that.
    posted by litera scripta manet at 4:59 AM on September 20, 2021

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