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Severe Alzheimer patient forgets how to push healthy soft stools out. Needs to be fingered out every 3-4 days. Tried all stuff to promote diarrhea - nothing. Not pleasant task. Guy is still healthy, likes to walk, eats well - lots veggies/fruit.
Any other suggestions to cope?

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How long does your person sit on the toilet? Usually there's a point when a person automatically goes without the need to push, just because! At least for a healthy person. I'm sorry, I don't know what the answer might be for an AD patient. Does the patient know he has to use the toilet? Is the urge there and he just doesn't push? My Dad will sit on the toilet for 10 or 15 minutes and eventually go (then go through the house with the used toilet paper in his hand!). He does say on occasion that he doesn't remember how to pee (sorry), but he manages to do this, also. Perhaps he just needs to sit for a period of time until he automatically goes. Hopefully someone here will have an answer for you! Hugs.
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If they are not going, you can try putting some Cilium in their diet, I have used the kind that dissolves in liquids of any kind, coffee, tea, milk, etc., I used to stir it into step-dads coffee. You can get the Wal-Mart brand, it is cheaper. Hope this helps.
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Is this your husband you talk about in your profile? What age? How long with the Alzheimer's? Did he ever have constipation problems in the past and/or take laxatives are enemas? Have any rectal surgeries or injuries?

With age or inactivit, the peristaltic action of the intestine slows down. Often even soft stools are not evacuated. Sometimes more fiber or even softer stools are necessary to get things moving. Have you discuss this with the doctor? Ask about docusate sodium (DSS), a stool softener. There are a couple of fiber additives that you can stir into water or juice and virtually disappears. I don't think you have any luck trying to get him to drink psyllium or Metamucil. I didn't with my mom. She never had any hard impactions or true constipation but because of surgery for an anal fissure many years before, she would get rectal blockages and the only way to get things started was digital deimpaction. Kinda sounds familiar. 2 doses of benefiber or citrucell + 400 mg of DSS daily, plus a good diet usually allowed for natural evacuation. Be sure to talk to the doctor first.
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Have you mentioned this to the Dr. at all? Sometimes depending on the medications that they are taking is a factor. Lots of fluids and fruit is needed. How is his ambulation because movement also helps to get things going. The muscles do get weak with the elderly, if he is getting enough fiber and such I would mention it to the Dr.
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I found that giving them fiber in a pill form as opposed to drinking it, such as Metamucil, etc. is very successful.
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This really isn't in response to your questions, you have some good suggestions to try here, but it made me think of something I learned. Elderly people think they have to have a BM everyday. They don't. Nor do we. Every few days is fine and no BM for a few days is no cause for alarm. Longer than that though and there needs to be intervention of some kind.
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I live with 60 year old stroke patient who is partially paralyzed. He walks a lot on the country property where we lived, so the gravity pull helps him. Still he does not always make it to the toilet-oh well. I give him a pill of probiotic plus yogurt everyday for to promote normal bowel texture and release. He does not drink water, so we give him watered down juice quite for dehydration. We use soaked prunes in his yogurt in the morning. Since metamucil is wheat and can cause diarrhea, so other forms of fiber are best. Dietary fiber can be even better, like brown basmati rice instead of white rice, or brown rice pasta for mac and cheese? I add cooked pieces of broccoli as well. Although high in fiber, beans of any nature don't seem to work though for Mr. P. Occasionally I will still add some white beans to spaghetti sauce though. A balance diet with plenty of protein and fruits seem to work the best.
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I use a form of Metamucil that dissolves in the liquid you put it in, but I also agree too much and it works the opposite way, with diarrhea. I agree Would discuss this with Dr. first just to be safe any way you decide to go.
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I went through the constipated stage with my mom also. Gave her stool softners and it did not help. Finally her doctor told me to get her some Miralax( I got the Safeway brand, it was cheaper). After about a week 1/2 she finally went. Now beware because she had to wear depends for about a week because by her have dementia, she could not control the loose stools. It was messy for a while because when I did start training her to sit on toilet longer because she does not remember to wipe herself when she goes to the bathroom, I have to coach her if I'm around when she goes to the bathroom. Now to keep her regular, I put fruit in her oatmeal, give her jello everyday for a snack. Try to give her vegetables at least 3 times a week. With the dementia progressing keeping her taste for foods is a everyday challenge.
Good Luck
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All very helpful suggestions for you to try. My first suggestion is for him to see his doctor to see if there is any blockage. I would not do a colonoscopy, but the doc could do a simple anal exam to check it out. He would also have some ideas of a good and safe medication to use to help him get regulated again. My husband has Alz. and is still continent, knows when he has to go. We eat a dish of Raisin Bran with frosted flakes every morning. Sometimes I add Cheerios. Aldi's has a great raisin bran and crispy cheerios and that is what we buy, much cheaper than name brands and just as good. Lots of raisins. I can't get him to drink much water except with his meds, so at least one meal a day, he gets a glass of water. It is true, a BM does not have to be an everyday occurrence, but kinda keep track of them. You could try a glycerin suppository, since you are finger cleaning every 2 or 3 days anyway. I have found that if I stay in the bathroom with him after I get him seated, it makes a difference. I have to tell him to drop the soiled toilet tissue in the toilet or he would throw it anywhere. He needs help to find the toilet seat also. Also try the adult Depends pull up underwear for men. They are wonderful and feel just like regular underwear, but the protection is there for accidents. You are not alone in your journey. This site is such a helpful one and we all can relate to some or all of what you are experiencing. xxxooo
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Thanks for all the replies and suggestions!
the guy is 80 yrs old and AD since 2002. so we are getting to the end, but it may be a long time coming as he is so fit. still walks, eats and sleeps well. mostly cheerful but can get easily tired when he will get violent a bit. does not really hit me - just threatens to do so! I follow the advice, leave him alone for a while to stew.Then I manage to get him in bed, he falls asleep immediately and wakes up angelic!
Was incontinent since last summer. Now, if timing is right, can pee in toilet but the poop is stuck. I can tell because a wipe is dirty. He has not wiped his own bottom for years! Pull up diapers are wonderful, hi-tech material means it can hold several pees too without getting sore cos of one way pass through layer.
He is not constipated. As there is indication of poop from a wipe - and even if I sit him on toilet for hours with a magazine to flip , he does not push out! the indication is there every 3-4 days. When we do a finger job, there are huge amts to pull out. He does not help much, but standing he does sort of bend a bit, which makes it easier to finger out. S o not constipated and this is why I am trying to give him diarrhea!
He eats oats daily, Plenty of green vegetables and fruit. Prunes and prune juice, fresh oranges, yoghurt, blueberries. You name it, he eats it. He has a very very balanced diet.
I could give him a soapy enema every now and then instead of the fingering. it will be real messy and not sure if he will submit to this as it is better done lying down. His comprehension is very slow , if at all, so he mostly does not co-operate.
coping with him for11 long years and I have had it. I wish he would die soon. Yes it is depressing, but I cope and have to get on with it. When he no longer recognizes me and is bed bound - I will get him into a home. By then it should be the end.
I do not think there is any suggestion I have not tried. there is no blockage - he just does not push any more.
Gwendo
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Have you spoken to his doctor? There is helpful medication for the aggressive behavior. You do the right thing by stepping away. His doctor should definitely know about the bowel thing and the behavior. Depakote will help settle him down and not make him sleepy. You're feeding him very well and doing a great job of taking care of him. Bless you.
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A variety of medications can cause constipation in anyone, especially the elderly. All above good recommendations, but I also found that 250 mg of magnesium once a day (natural mineral supplement) is a very good muscle relaxer (including the bowel muscle). I had been giving that to my Mom at home, but when she went into Rehab they did not give the extra supplements I was giving her at home, and she ended up impacted and they had to "digitally de-impact" her (UGH!). I had a chat with the Rehab doctor and he agreed to start giving her the magnesium. Now that she is in a NH I requested that they include magnesium in her Rx & vitamin regimen, and she has not had a problem. To the best of my knowledge she is regular and goes at least once a day. It's worth a chat with her doctor.
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Doc not much help - gave him a suppository which did absolutely nothing. She gave me huge bottles of a lactose solution - for constipation - he is not constipated I kept telling her! I do give him the dosages now too.
Ativan keeps him calm. I used to give him a dose daily, but he also just got sleepier and sleepier. It works within 1/2 hour and he is very happy and co-operative and then passes out almost! I managed to get away for 10 days to see my son. On my return he was so happy to see me, that I stopped the Ativan. he has been off it for over many weeks now. Beginning to get more grouchy and so I give it sometimes. I think it builds up in the body too much.
Come to think about it, the bowel problems began around when I went off in March. My absence triggered it? The report I heard was he was quite happy and manageable in my absence. I found a wonderful live-in helper last year and she saves my sanity. gwendo
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Gwendo, just saw your thank you comments above. So dad is not constipated, he just does not push. I wonder if the magnesium would help anyway, as it relaxes the bowel muscle, and he may not need to push in order to release. Since you are looking to create diareah, this may soften the bowel a bit more without the messy diarreah. I cannot imagine handling your Dad's situation as long as you have. God Bless you! I hope you will consider putting him into a facility sooner than later, and get your life back. You can be just as diligent making sure they keep him as clean as you do, without killing yourself in the process. You can visit frequently and then go home and sleep nights. He will know you love him just as much. I don't mean to be presumptuous, but how long can you keep up these Herculean efforts?
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You're doing the Lord's work, Gwendo. I can't even imagine what you've gone through in your quest to take such wonderful care of your Dad. Keep on keepin' on - as long as you've found someone to give you in-home relief and you can manage...you have to do what you have to do. God bless you. We're all with you. xxxooo
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My mom knows when to go to the restroom also. She does forget to wash her hands. The other day she had a BM and asked me what it was. I didn't and still don't know whether to laugh or cry. Blessings

PS...GREAT advice from all of you for my future reference!
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blogs like this one are wonderful for morale - to know you are all out there. I can sit and cry and feel comforted. It is a long haul.
It is a spouse, married for 54 yrs and knowing all his funny habits, its hard to put him in a home as we are coping still. I am very fortunate I am very fit n healthy with physical strength to push and pull him. though this is getting harder.
Before he became completely incontinent, nights were very disturbed. Pooping was no problem either. Now I sleep all night! How to do it?
I got a hospital type bed, so he is 'trapped'! Now easier to pull him up too.

I change from pull up to wrap round diaper at around 11pm and also hope to get him to pee in the toilet first. I try to make sure the diaper is higher at the back than at the front - not easy as spouse is not helpful and his hands hang on the diaper as he stands.I need to take it slowly!/. When all done we can all sleep the night until morning. Sometimes the towel and plastic sheet under him, as well as his pants are wet by morning, sometimes if diaper done well - all is clean!
Another tip is to give him shorts to wear at nights that has tabs for a belt and to belt the shorts tightly. Men like to put their hands into their pants and 'fiddle' - pee comes out all over the stomach and the bed! Now that problem is solved!

Showers just take a bit of time to persuade him to go into the shower. Once in we get it done very quickly, sometimes some resistance.AD patients cannot see water and it frightens them.

I do manage to have a life as I send him out to day care daily. I am lucky to be able to afford this, as well as a live in helper since last year. It costs me less than residential care.

so my one problem is the poop! I will try giving him magnesium as one of you suggested. I take them myself as I get night cramps when I walk too much.

It is these last three years as we go into end stage that has been hard. After what was a long and happy partnership, it is the least I can do for him - even though it has become more of a hate relationship now.

The end must be near soon!
Gwendo
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You do not say what stage your "guy" is in, but in Alzheimer's disease, the brain doesn't communicate with the rest of the bodily functions. You can try a fleet enema, take Probiotics (there is a new one out with 25 Billion cultures and does not need refrigeration at GNC - just purchased some). Taking magnesium will stimulate peristalsis (bowel movements - try 3X a day at 100 mg. each tab - that works for my guy), and keep feeding him as much as he can tolerate along with lots of water/fluids (but no sugar drinks). Coffee is stimulating if he can tolerate it. Good luck, constipation is the primary complaint in elderly patients who take medications. It is always on the side effects panel. As a nurse, I read everything, and if it is constipating for my husband, I don't buy it. Good luck and let us know how things come out! Pun intended...
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Diagnosed in 2002, it is end stage now, with incontinence, loss of speech and loss of skills, slowly over this recent 3-4 years Nothing else wrong healthwise. Since two weeks ago, taking SINEMET to help with rigidity. That is sort of working as his fists are less strongly clenched and his legs less heavy to push up on bed. He actually can sit and stand up with less pull by me too.

Caregivers of AD need to be smart.,Doctors not much help. If you tell them they are getting rigid - is it Parkinson's - they will say maybe but offer no other help. I need to go on-line, look up symptoms, find if there is medication and then go see the doc and tactfully ask if SINEMET might work! So no help with the bowel problem either, except to treat as constipation!

thanks, Ferris1, for suggesting magnesium. given once so far - 175mg and going into 2nd day. Interesting! In middle of last night for a diaper change. he is sitting on toilet, did a pee and unwilling to get up. Asked if he has poop. He says yes! I did not believe and got him up and yes he has poop indications when wiping his bottom. But he still does not push and we need to finger it out. but it is a step forward that he knows he needs to poop. And this is less than the 3-4 days since last 'fingering'.

So with more magnesium and Sinemet, we may have more reaction. I will keep you all posted!

Thanks for all the hugs and encouragement. We all sure need it with this terrible disease.

Gwendo
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Magnesium is great for better pooping. The FORM of magnesium is important too. If he's still able to swallow pills, MAGNESIUM OXIDE is the ticket. If pills are difficult to impossible, try cherry flavored Milk of Magnesia, which is palatable and I think the active ingredient is MAGNESIUM HYDROXIDE. These forms of inorganic magnesium mineral tend to stay in the intestinal tract and hydrate the colon, making pooping easier.

As and aside, if you want a magnesium supplement for nutritional deficiencies or because a doctor has recommended it to aid in heart function, my opinion as a nutritional consultant is that the best contains Albion (patented lab process) chelated Magnesium Glycinate as the most effective and biologically available form. Magnesium glutamate and magnesium aspartate should be avoided. Magnesium Citrate probably won't hurt you but isn't as absorbable as the glycinate. Albion licenses the use of their ingredient too many well known brand manufacturers, although they tend to be costly and not discounted. I I have found that Swanson vitamins.com use Albion in some of their private label mineral supplements at quite a savings. Caveat: the caution here is to read the label ingredients because once and also carries some of the mineral forms that I do not recommend.
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correction ... because SWANSON also carries
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Hi Gwendo, that magnesium seems to work well. Ferris's suggestion of 100mg 3x/day is very good, or you could use 250 mg 1x each morning and that works for me as well as for my Mom. The trick is getting to see what amount works well without causing diarreah. Too much will cause diarreah, and the best effective amount will produce a soft stool that doesn't require much pushing if at all. I see you found a 175 mg tablet that has already shown a promising result. Sounds like you are on the right track! I wonder if the Sinemet that reduces muscle rigidity is helping in combination with the magnesium. You will see as you go along what dosage and combination works best for your husband.
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cvs sells chia seeds in pint jars. one teaspoon of those boiled for just a moment and added to tapioca pudding does a great job. also loosen up that diet. the only meat that digests well is skinless chicken . the easiest food to digest is hands down rice. it is high energy for the amount of energy required to digest it. gelatin also slicks up the bowels but if your looking at last resort solutions make with the red beets. bread dont digest worth a damn. we love our whole wheat , meat / cheese stuffed brotchen rolls around here but sadly moms digestive tract wont break em down anymore.
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veg soup with cut up chicken breast goes over good around here. a splash of ranch dressing and a flour thickener makes this stuff irresistable..
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CarolLynn: Thank you for clarifying the different forms of magnesium to use for different purposes - very helpful info. I just checked the bottle I have been using and it just says Magnesium 250mg. The fine print under Ingredients specifies Magnesium Oxide. It's a round tablet, a bit bigger than an aspirin, and as you said, great for poop issues!
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I also just checked - 1 bottle is 175mg magnesium oxide +calcium 350mg +zinc gluconate 10mg and suggests 2/day. The other bottle has the oxide and stearate 400mg +calcium carbonate 1000mg + zinz sulfate15mg + other gunk and suggests 3/day! I am using the first pills for my AD spouse and take the other for ME!

One good thing about end stage is the patient sleeps a lot during the day. The brain is diminished and gets quickly tired with any kind of activity ranging from a shower to eating a meal. This gives needed respite for me as at week ends, I am coping on my own.

Pills have to be ground up and mixed with food as this patient spat out large capsules/pills a year ago. He does not seem to mind powders on a spoonful of any food. I also need to give liquid forms of Omega fish oil.

Thanks for all the tips. This is a wonderful blog to get needed helpful info.
Gwendo
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Glad my suggestion helped! Every body is unique. What works for one, does not for the other. With Stage 7 Alzheimer's the bodily functions will continue to slow and the rigidity as well. My best thoughts to you and prayers for all that you endure.
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Gwendo you are doing a fantastic job. Try placing hubby's feet on a low stool while sitting on the toilet, it simulates the squatting position used by our ancestors and less advanced cultures today and may help. Try giving him a massage with warm oil while on the toilet with special attention to his lower abdomen using as much pressure as he will tolerate. Be careful with the diarrhea because sometimes people leak liquid stool around an impaction.
Lying down for an enema is the ideal position but if you insert the catheter as high as possible before he sits down you can do it on the toilet. You need a regular large guage catheter which can be reused if necessary many times and as much as several pints of warm soapy water. It won't harm the rectum as it runs right out into the toilet like a lavage
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Just another note on magnesium, gwendo especially:

For SYSTEMIC (internal, cellular) supplementation, the body is is calcium and magnesium in an approximate 2 to 1 ratio. That's why many supplements contain both calcium and magnesium. If you want the highest level of biological activity and assimilation, please consider the magnesium glycinate, as stated in my previous post. You probably won't find this yet in a combination pill because it is a newer form of magnesium. If you want to take it in conjunction with calcium, please take Albion chelated form of calcium or calcium citrate (such as CitriCal) as a second, but not preferred, choice. Calcium carbonate is a cheap calcium ingredient and not highly absorbable compared to chelates. If you want to take both calcium and magnesium for systemic supplementation, it is much better and more bang for your buck to buy individual supplements made the best ingredients.

If you want the magnesium to be staying in the digestive or intestinal tract and not be absorbed much for the body then plain, unadulterated, magnesium oxide (pills or pills crashed into powder) is the best choice. As posted earlier, the magnesium hydroxide and milk of magnesia is also effective (Phillips cherry flavor is the most palatable). As has been posted by users of mag ox, you have to adjust the milligrams differently for each person to get the best results. You should not use a calcium magnesium combo supplement when you're trying to affect bowel function. If you think systematically, using a magnesium oxide intended to stay in the bowel in combination with a calcium intended to be absorbed, you will inadvertently the throwing of the systemic Cal Mag balance.
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