By Amy M. Collins, associate editor
Photo by Sevda Cordier-Dirikoc / GE Healthcare, via Flickr*
Last October, I wrote a blog post about my grandmother, who is 85 and suffering from the first stages of Alzheimer’s disease, and about the failure of many providers to assess and treat the underlying cause of a sudden and extreme acceleration of her dementia symptoms (mania, agitation, and violence, along with nonstop, nonsensical talking).
The post generated a slew of comments on both the blog and Facebook, with over 20 nurses suggesting the probable cause for her symptoms to be fecal impaction or urinary tract infection. They were right. But several physicians and specialists had been shockingly wrong, diagnosing her with everything from closet alcoholism to VERY-late-onset bipolar disorder.
My grandmother did, in fact, have a severe fecal impaction, finally diagnosed—after several weeks of family turmoil—by a nurse in an ED. She was treated, and within a few weeks her symptoms slowly dissipated. I’m happy to say that she’s now back to her sweet and gentle self, with no memory of the episodes she herself would have deemed crazy.
Although her Alzheimer’s symptoms are still heartbreaking (she recently introduced me to a fellow assisted-living resident as her ‘special friend’ instead of her granddaughter), she isn’t agitated, hallucinating, accusing people of stealing, or showing other signs of the previous mania. At a recent family visit, she spoke of her plans to attend a luau at her facility, and requested a grass skirt!
Chronic constipation in the elderly isn’t a rare occurrence, especially in patients with dementia, but unfortunately the outcome may not always be as favorable as in the case of my grandmother. Our August CE by Leah Craft and Joseph A. Prahlow, “From Fecal Impaction to Colon Perforation,” describes the case of a woman in her 70s, nonverbal and suffering from Alzheimer’s disease, who developed a fecal impaction and eventually died.
Although the woman had trouble communicating, for several days she moaned and pointed to her back—but wasn’t brought to the hospital right away. Even after she was hospitalized, and despite interventions, subsequent stercoral perforation of the sigmoid colon resulted in peritonitis, sepsis, and death. The authors suggest that the patient might still be alive if the changes in her behavior had been recognized as signs of pain and if constipation had been considered.
According to the article, people with cognitive impairment have an increased risk of constipation, fecal impaction, and stercoral perforation. Immobility, a decreased awareness of thirst, and difficulty in communicating pain and discomfort can all contribute.
In my grandmother’s case, her worsening short-term memory loss makes it hard for her to remember what time of day it is, whether or not she’s eaten, and whether or not she’s used the bathroom. To prevent her experience from repeating itself, the caregivers at her facility have now added a stool softener as part of her daily care plan.
Considering the parallels to my own personal experience, the case in the article truly touched me. And I’ll always be grateful to the nurse who correctly diagnosed my grandmother’s problem before it was too late. With people living longer and the likelihood of cognitive impairment or dementia increasing with age, all health care providers should be aware of the risk of fecal impaction and its potentially deleterious outcome. The August CE provides excellent information on fecal impaction and the added challenge of dementia, ways to avoid colon perforation, and the nurse’s role in managing constipation in the elderly.
*The photo depicts a primary culture of hippocampal neurons stained for DNA (blue), βIII tubulin (red), and neurofilament NF-H (green). Alzheimer’s disease.
My stepmother, who I care for, is constipated and I tried giving her an enema. She couldn’t seem to push though. This is all happening today… Any suggestions on what to do?
Thank you for your post. It is imperative that caregivers understand the severe complications of colon impaction, including death. This is also very common in children with autism, along with many other disorders which both alzheimers and autism have in common…..including the primary cause of both being mercury and aluminum toxicity due to vaccinations which contain high levels of these metals which accumulate. One single flu shot has 25,000% of the EPA safety standard for mercury, and most other vaccines have high levels of aluminum, both known to be neurotoxic. The other major contributing factor is that the healthy intestinal flora has been wiped out, either by antibiotics, vaccines, or both. The good news is that probiotics and prebiotics will replace the missing intestinal flora, which is neccessary for digestion. Probiotics along with digestive enzymes ensure proper food digestion, which then prevents constipation and impaction. Also aluminum and mercury can be removed safely with natural therapies: magnesium (malate), glutathione, methyl B12 shots, chlorella, modified citrus pectin and modified algin(ate). Please search online for this information. Search “Alzheimers”, “Mercury”, “Aluminum” at Dr. Mercola’s website, which is the most widely read alternative medicine website in the world.
My 87 yr old mother just suffered from a fecal impaction while I was out of town for 4 days. Upon my return I had to take her to the ER where it was digitally removed and a soap suds enema was given. Since that time she has not been able to remember to put on another Depend when she takes one off, wears her Depend on the wrong side of her clothing, can’t figure out what to do with the toilet tissue after using it, rolls up the used Depends and puts them in the cabinet and using soap instead of toothpaste …etc. She was unable to figure out how to remove her bra one evening and resorted to cutting it off with scissors. After 3 weeks we had to move her from Independent living to Assisted Living. I am trying to get Speech Therapy to help her “remember” these very normal actions but that has not started yet.
To make things more interesting another elderly woman in the same IL home had an impaction about 3 wks after Moms and she is experiencing memory loss too.
Does anyone know what can be done for this memory loss?
Just realized myself that constipation does cause a great deal of stress for people with dementia. My parents have moved in with my family and after 8 months of having mom and dad here I am slowly changing their diet. They both now take movicol. I now realize constipation was a problem for mom for a long time. I sometimes wonder if constipation triggers dementia. Mom was also low on b12. I always ask questions and google what I dont understand. I want to give my parents the best quality of life. Knowledge is the best tool. My mom is 83 and happy. I would say to people, that have elderly parents, get involved as much as possible remember they looked after you when you were little.
Thank you for your article,we are experiencing the same situation with my mother who is eighty years old. My brother who recently became a care giver is in total denial of her progressive dementia, as far as I can remember she always had problems with constipation, now it is worse!
Just this afternoon while visiting my mother, who is later stage Alzheimer’s, I noticed once again that she seemed to be in pain. Last week I observed her with the same grimacing and sounds that I felt were from pain. She was found to have a bowel impaction and the nurse removed it. When I brought it up this afternoon, they looked at her chart and found that once again she had not had a bowel movement for several days. She was given a very warm shower and then checked for an impaction. Once again, she was severely impacted and went through the removal procedure. My mom is given sienna twice daily to help keep the stools soft, but this is not working. I am very concerned and will be speaking to her Hospice nurse and the floor nurse in the morning. Thanks for your article!