Archive for the ‘Bowel and Bladder’ Category

Posted on October 6, 2010 - by Nurse Virginia

CONSTIPATION – NOT ALWAYS JUST A SIGN OF AN AGING ELDER

Results of Laxative abuse in the elderly.

Many elders abuse laxatives without realizing their regular use is abusive. The elder may be under the assumption that in order to be “regular” they must have a bowel movement every day. Regular use of laxatives makes the intestinal muscles flabby or referred to as a “Lazy bowel.” The ongoing use of these products eventually makes a person dependent on a laxative in order to have a bowel movement.

Laxatives work by irritating the walls of the intestines and causing an increase in the contractions of the muscles in the intestinal wall. The most gentle of these products contain milk and increase the amount of water in the intestine causing a softer stool. The nursing home usually favors the use of one of these milk products (Milk of Magnesium or MOM) for the elder with a constipation problem.

Suppositories

Glycerin suppositories have a more gentle action than Bisacodyl products. Glycerin works by attracting water through the intestinal wall into the bowel and will flush out the waste within 10 minutes. All suppositories are bullet shaped and designed for insertion with the pointed end first and placed next to the wall of the bowel.

A Bisacodyl product acts by irritating the muscles of the bowel, causing contractures (at times extreme) which expels the waste.

When Hypothyroidism is the cause of constipation.

When the elder has an ongoing problem with constipation despite eating a good diet, drinking water through out the day and getting regular exercise, the possibility of hypothyroidism should be looked into. Although hypothyroidism causes dementia, as well as a host of other conditions, physicians are more likely to address each symptom then the cause. A diagnosis of hypothyroidism is very difficult to receive from a physician.

The patient who presents with slow reactions, and moves slowly, you can then assume their digestive system is also moving slowly. A slow moving colon gives the intestinal wall more opportunity to remove fluid and create hard dry stools.  Even when the physician suspects Hypothyroidism, unless their lab tests confirm it, the patient will not receive the diagnosis. Hypothyroidism used to be diagnosed strictly by the symptoms reported by the patient and the observation of the physician. Once the medical community determined that the only way to determine this debilitating condition was with the correct labs, many people were no longer diagnosed.

Although hypothyroidism is relatively easy to treat, with low cost thyroid medication and iodine the typical physician is going to dismiss this possibility if the labs don’t back him up.

Although constipation is a difficult condition to live with, the missed diagnosis of Hypothyroidism has the potential to cause many more conditions for the aging population in the future.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on October 4, 2010 - by Nurse Virginia

CONSTIPATION – NOT ALWAYS JUST A SIGN OF AN AGING ELDER

(PART II)
Constipation – the difficult passage of hard dry stool.
After food is swallowed, it begins to digest in the stomach where it is broken down into small pieces. Food then continues into the small intestines where it is digested by enzymes and nutrients are absorbed into the bloodstream, as it passes through the many feet of colon. A large amount of fluid is needed for this process. In the large intestine almost all of the fluid is re-absorbed, the remaining substance is waste. This waste is made up of unabsorbed food, fiber and water.
The fiber story.
In 400 B.C. Hippocrates said, “Let food be your medicine.” This couldn’t be better advice than in the case of fiber. Fiber is the part of the plant that can’t be digested. So fiber that is eaten will then be intact in the stool. But fiber not only passes through the system without being digested, it also attracts water. Because fiber has the ability to attract and hold water, it makes the stool a softer consistency and therefore easier to pass.
Benefits of fiber:
·    Loose watery stools – fiber will absorb the excess water.
·    Decrease the size of hemorrhoids due to the reduced need to strain when having a bowel movement.
·    Fiber decreases the absorption of sugar which can be a benefit for diabetics.
·    Fiber improves problems of constipation.
Sources of fiber from food:
·    Whole-grain products
·    Fruit – eat the skin whenever possible
·    Vegetables
·    Legumes
·    High fiber snacks – nuts, seeds, popcorn, whole grain crackers and dried fruit
Fiber found in food will always be superior to the use of fiber supplements.
Some elderly will have a problem tolerating a high fiber diet. These problems may be abdominal pain, cramping or gas. Your physician may suggest an over the counter supplement or testing to determine if the problem of constipation may be related to hypothyroidism.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com

Posted on September 30, 2010 - by Nurse Virginia

CONSTIPATION – NOT ALWAYS JUST A SIGN OF AN AGING ELDER

(Part I)

Statins (Cholesterol Drugs) cause muscle weakness – the colon is a muscle

Charles was 85 that year. His family was aware of his constipation problem. He, like many other elderly people incorporated prunes into his morning routine. Charles came up with his own solution of a hot cup of coffee first thing in the morning with ginger snap cookies heaped in the coffee like a hot cereal and prunes. One of his daughters’ brought him apples, encouraging one a day, which he faithfully complied with. Everyone was coming up with suggestions for a “fix” to this problem of constipation.

Yet Charles ended up in the hospital with a painful and unnecessary bowel obstruction. The first thing the hospital physician did was to review his medications and discontinue the statin drug that caused the problem.

Charles’ daughter was told by the physician that they were getting elderly patients in every month with bowel constipation related to a statin drug.

Signs of muscle weakness.

Now after the fact, Charles’ family could see the signs of weakness they had just assumed were the effects of aging. How he had started to complain of no longer being able to walk as far as he used to and had to sit down frequently because he felt weak. How now when walking in his retirement community he was holding on to the rail along the wall and using his cane. Previously, he had never used a cane and could keep pace with his much younger children when walking the halls.

The 22 foot muscle.

When people reference their muscles they rarely mention the digestive tract. The colon in an adult will be anywhere from 12 ft. to 22 ft. long depending on its musculature tone. Food is digested by enzymes and moved through the colon by involuntary muscle contractures. The tone of the muscular walls of the colon is very important to how fast food travels through the digestive system.

Any drugs that have the potential for causing muscle weakness should be suspect when constipation is an issue.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on April 2, 2009 - by Nurse Virginia

CAREGIVER TIPS: When the elder suffers the embarassment of incontinence.

The shame of incontinence.

  Her family told us that for the last few years their mother had refused to wear any incontinent product. She collected and sat on piles of newspaper at all times. This had become her normal to a point where she became very angry when anyone even suggested that she was incontinent. During her time with us, she could be seen wheeling around the community searching out discarded newspapers.

 Even after we had successfully convinced her to wear “pull-ups” that we always referred to as “her underwear”, she continued to collect and sit on newspaper. 

4 Things to remember when your elder is incontinent.

·                     Make sure the person drinks an adequate amount of fluids. Many people as they begin to have incontinent problems think it will be better not to drink too much, and start restricting their fluids. 
 

·                     Be careful what you call the incontinent product you use. The word “diaper” is only used with babies. Refer to incontinent products as underwear, underpants, boxers, any adult term that doesn’t make the person feel they are being treated like a baby.

·                     Take the person to the bathroom at regular times. Right when they get up in the morning, right after all meals, before they go to bed and any time you can tell by body language that they need to use the bathroom. This could be facial or body gestures of discomfort or anxiety.

·                     Be very careful in your response to incontinent episodes or toileting. It is much easier for the person you care for if you have a very matter of fact attitude.

 I remember a retired nurse I once cared for. She asked me if I knew why when the staff came into “change her diaper” at night she always kept her eyes closed. I had always assumed it was because of the staff having a light on to see what they were doing. And that the light had bothered her eyes. She told me “No, I don’t want to see the faces of the people who have to do such a humiliating thing for me.” 
Incontinence is hurtful at any age.

Posted on March 23, 2009 - by Nurse Virginia

Caregiver Tips: When the senior you care for has Alzheimer’s disease and suffers from constipation

Constipation may be related to aging or Alzheimer’s.

Constipation is frequently a problem for persons with Alzheimer’s disease. Due to the fact that the same substance that is gumming up the connections in the brain gum up the intestines. When that happens the intestines slow down and slowing the work of the intestines causes constipation.

The intestines can also slow down due to aging and weakened muscles. When your other muscles get weak the muscles used to move food also get weak. Besides aging this can also happen as a side effect of some medication and also your food choices.

Reduce foods known to cause inflamation.

The first thing to try would be do try to eliminate sugar and white flour from the diet. Many times if the person has sensitivity to wheat or dairy you can find that out by eliminating it from the diet for a while.

Increase the amount of water the person drinks – try for the 8 ounces a day that is a standard recommendation. Increase the amount of fruit and vegetables that are eaten. Also some meats are more difficult to digest than others with fish and fowl the easiest to digest.

Tracking how often the person has a bowel movement and how difficult it is for them is just the start of a good bowel program