how long is too long?
August 17, 2006 5:19 PM   Subscribe

My elderly dad is plagued by not "being regular" (ok squeamish ones, you can stop reading now if the subject grosses you out)

It has happened time to time and sometimes the heavy duty by prescription stuff helps, sometimes it doesn't.
This time it isnt and he (with his doctors permission) is doubling the dosage on bottle. No go.
It's been 7-8 days now and I'm worried. At five days when I talked to his doctor (who I do like and trust) didn't seem concerned which he was all too happy to hear because he is embarrassed about it and I guess it's none too pleasant to have it taken care of, um, manually.

How long is too long? Could it be some type of bowel obstrution?

He takes the stuff they give you to clean you out before surgery, etc, powder liquids you name it.
posted by beccaj to Health & Fitness (10 answers total)
Prune juice. Seriously. It performs as advertised. Have him drink two tall glasses of it and wait a few hours.

If I were in this position of not having crapped in a week, I would do the prune juice thing as a last resort, and then I would see my doctor.
posted by Dr. Wu at 5:30 PM on August 17, 2006

I'm not trying to scare you but I think it's approaching the point where it starts getting more serious, especially at that age. There are some people who normally only go once a week (although I must admit I don't see how that works myself) but in most people that's an unusually long time, especially with 'help'. Is there any sickness, nausea, etc? Those are not good signs and would hint at an obstruction.
posted by wackybrit at 5:33 PM on August 17, 2006

Glycerin suppositories may help him, and have no medical side effects. Disposable saline enemas can also be useful in cases of moderate impaction.

Older folks can have more problems in the summer with impaction, if they become slightly dehydrated and don't feel like cooking or eating as much as they might in cooler weather. The large intestine removes more water from the feces when the body is dehydrated, which can slow throughput, and the sense of thirst is not always a reliable guide to replacing fluids and electrolyte salts in warm weather. Gatorade or similar electrolyte balanced sports drinks are very helpful to older people in keeping balanced in warm weather.

Lubricating the bowel with glycerin, and injecting saline fluid are the two non-medical interventions most likely to produce short term results. If he goes more than about a week, as he already has, impacted feces can become a serious obstruction.

Preventative measures are best, including taking more fluids than he may feel he wants to, and adding insoluble fiber to some of the additional fluids he drinks.

And if he's never had a colonoscopy, it's high time.
posted by paulsc at 5:38 PM on August 17, 2006

Thanks so far...

He is on a regular diet of 100% Bran and prune juice everyday.

For the past 3 days he has been taking 2 doses of GlycoLax.
I bug the guy SO much about having plenty of water, eating less processed food, exercise, etc.
He has had a colonoscopy. And as for this bout of constipation.. he has done emenas-- it seems like the feces isnt that far along in the process.

Extra question.. I just ran to CVS and got mineral oil.
Anyone see any harm in giving some of that along with his GlycoLax?
posted by beccaj at 5:50 PM on August 17, 2006

Oh and he doesnt have any other symptoms but he is getting a little uncomfortable.
posted by beccaj at 5:51 PM on August 17, 2006

Sounds like you and he are doing the basics, beccaj. One of the issues that is important in assessing the problem is to try to understand where the impaction is occurring. If he feels that the problem is in the area of the rectum immediately inside the anus, suppositories, mineral oil, and enemas all can be of benefit. But if it has been a few days, the feces may be so dry as to be difficult or impossible for the bowel to move by normal peristaltic action; treatments which can introduce moisture and lubrication may need to occur several times over several hours to have effect. And frankly, if it has been a week for a person who normally has daily bowel movements, it may already be a situation where manual disimpaction is needed. If the bowel is full of hard matter, it is easy for bowel tissues to be torn by straining.

So, if he can't go within several hours of receiving and retaining saline enemas and mineral oil or suppositories, you need to move on to manual disimpaction, which he may be able to do himself if the feces are in the low end of the rectum. For impaction higher in the colon, you may need to take him to the ER, where they regularly see such problems in older people.
posted by paulsc at 6:30 PM on August 17, 2006

This is beyond the prune juice and fiber recommendations and if he does have an obstruction the stimulant laxatives aren't the best choice. It is likely he has a dried and difficult to pass stool. The glycerin suppositories or enema suggestions above are good.
I would add (and the reason I felt it necessary to post) that it might be secondary to some medication he is taking. Pain relievers that are opioids can slow bowel movement and cause constipation. Since you don't want him to be in pain, tapering off of these for a bit might be problematic. However, a variety of other drugs are anticholinergic and cause these problems. There are often other options that perform the same good effects of these drugs without the constipatory effects.

First generation antihistamines are notorious for this. If he isn't taking them for allergies, he might be taking them for sleep. A second generation antihistamine, although less powerful for allergies, may be sufficient for him. As for OTC sleep medicines they may be causing the problem and they are not that good to take for long periods anyhow.

There are many other drugs with anticholinergic effects. These include older antidepressants (not Prozac or SSRIs) and some drugs that are heavily marketed for maintaining urinary continence (e.g., Detrol, tolteridone). I am skeptical of using anticholinergics for urinary continence, not because it can't work, but because of the potential side effects.

The Rome Conference on Constipation back in the 90s defined normal number of bowel movements as between 3 times per day to 3 times per week. Your father is well beyond that. If the suggested measures don't work soon, he should be checked for obstruction.
posted by dances_with_sneetches at 7:25 AM on August 18, 2006

Lots of water, if he can. Also, a friend with serious constipation issues who hadn't gone in almost two weeks was told by emergency room staff to use a mineral oil enema, rather than the saline. They said that, after some time, the saline ones can be rather ineffective. They also said to avoid Tums and similar antacid products.

I was later told by said friend that the mineral oil enema worked when nothing else did. Unfortunately they can be hard to find, but are made by the same manufacturers as the saline ones. I think the box is orange.

If all of this produces very watery diarrhea without a solid movement, I believe that could indicate an obstruction -- which, of course, is a very serious matter and should warrant a trip to the Doc.
posted by penchant at 7:47 AM on August 18, 2006

I want to thank everyone for their answers...

:: sniff sniff :: I love AskMefi

We are headed to urgent care for 2:30.
Thank you
posted by beccaj at 10:56 AM on August 18, 2006

let us know.
posted by dances_with_sneetches at 12:59 PM on August 18, 2006

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