You guys have been so helpful on the sheath-catheter thread, I thought I'd sound you out on laxatives...

Uncle was at sea for most of his life, and as ships master was in charge of the medicine cabinet. He was brought up to believe that a daily bowel motion was essential, and for as long as anyone can remember he has used laxatives to ensure that it happened. Cascara sagarada was his laxative of choice, but about fifteen years ago he was moved onto lactulose. When he moved in with me I discovered that the lactulose was no longer working and gradually weaned him off it and on to psyllium husk mixed in with his porridge. For two years he used virtually no other laxative, but six weeks ago after the fall he seemed to lose the ability to 'go' naturally.

All the info I get on the internet is geared towards prevention. I've already got him eating as much fibre and drinking as much water as possible, though in truth I'd like him to drink more. Exercise isn't really an option, and he's already likely to be fairly dependent or immune to most laxatives as I think he's been using them for at least fifty years.

I keep a chart (I know, I know, it sounds obsessive....) and it seems that if I dose him with cascara every four days, it seems to cause a fairly predictable bowel motion around 16 hours later. If I use senna, it gripes him and empties him out totally, but the cascara just seems to kick start the muscles in the rectum and leave the other muscles alone. If I don't dose him, he gets uncomfortable and stops eating so I'm loathe to leave him longer than four days. I think it's unnecessary to do it more frequently as he seems comfortable until then, eats well, and the poop is still nice and soft and he can pass it without straining.

But how long will the cascara keep working like that? Should I be alternating with different types of laxative? Or using suppositories or mini-enemas every now and then to give his body a break from the cascara? Should I occasionally experiment leaving him an extra day in the hope that his body will initiate a bowel movement itself without any help? Or should I just keep going as I am on the grounds that he's comfortable like that and just deal with it later if it stops working?

BM monitorings are an important part of caregiving. Good job!

I'm currently using an organic herb tea called "Smooth Move" by Traditional Medicinals. It contains senna, fennel, licorice, orange, cinnamon, coriander, ginger.
Using the three day rule, it seems to work.
Thankfully so! This seems to be a problem no matter what I do feed her.

And if hes on ANY type of pain killers you need to make sure those bowels are moving to prevent impaction
Those will stop him up faster than a...well quick.
Now Im not quite sure what it is you have tried in the past that was natural but a few of us have tried a product call Fruiteze (my lifesaver with my MIL who is prone to impaction) one word PAINFUL!
Be careful of the enemas also make sure when you have to do it it enters the anus only 1 inch no further some folks think you got to shove that thing all the way up to the neck of them and thats how tears occur
Heres the website for Fruiteze if you decide you want to try it out:
http://www.fruit-eze.com/
And please your not being obsessive that is wonderful your charting these things it helps the Docs out if you need to take him in to see them it gives doctors a better idea of whats going on
Rule of thumb on BM's and how long in between is 3 days then you take measures, thats standard across the board.

My Mom was the same way with me as a kid.She thought I had to go every day,so out came the Cascara........I hated it & at some point I refused the stuff.I never use laxatives.......

quote:

Uncle was at sea for most of his life, and as ships master was in charge of the medicine cabinet. He was brought up to believe that a daily bowel motion was essential, and for as long as anyone can remember he has used laxatives to ensure that it happened. Cascara sagarada was his laxative of choice, but about fifteen years ago he was moved onto lactulose. When he moved in with me I discovered that the lactulose was no longer working and gradually weaned him off it and on to psyllium husk mixed in with his porridge. For two years he used virtually no other laxative, but six weeks ago after the fall he seemed to lose the ability to 'go' naturally.

All the info I get on the internet is geared towards prevention. I've already got him eating as much fibre and drinking as much water as possible, though in truth I'd like him to drink more. Exercise isn't really an option, and he's already likely to be fairly dependent or immune to most laxatives as I think he's been using them for at least fifty years.

I keep a chart (I know, I know, it sounds obsessive....) and it seems that if I dose him with cascara every four days, it seems to cause a fairly predictable bowel motion around 16 hours later. If I use senna, it gripes him and empties him out totally, but the cascara just seems to kick start the muscles in the rectum and leave the other muscles alone. If I don't dose him, he gets uncomfortable and stops eating so I'm loathe to leave him longer than four days. I think it's unnecessary to do it more frequently as he seems comfortable until then, eats well, and the poop is still nice and soft and he can pass it without straining.

At this stage of the game, his body is inured to laxatives. That isn't going to change. With him being bedridden now, he is much at-risk for impaction or obstruction, so it is imperative that his BMs keep chugging right along.

Oh my, Olivia, you get right to the best topics. Daily bowel movements are an obsession for many. (I am pretty fond of them myself to tell the truth). When Mom was in charge of her own toileting she used a bulb enema at least twice a day and major doses of psyllium as she had been advised to do after surgery for hemorrhoids 25 years previous. Somehow I don't think her surgeon meant her to keep it up the rest of her life.

Anyway, 5 years ago when she was in the hospital for a while her PCP insisted that WE had to make her stop this and retrain her system (oh joy . She was as mad as a wet hen when we told her the bulb was lost at the hospital and the store was out of them. At first we relied on lots of fruit, including stewed prunes, a high fiber cereal (sticks and twigs) Milk of Magnesia, stool softener, you name it,,it was in the cupboard. Gradually we weaned her off the M of M and the stool softener and started using Mira-Lax if she missed 2 days. That is pretty much how it went for a good while but now she is less ambulatory (well, she requires a whole lot of assistance to walk 5 ft, but she can stand and take a few steps). Lack of mobility makes a big difference.

Now Benefiber goes in just about everything (it dissolves completely and can be in juice, water, tea, pancake batter, smoothies, milkshakes, I have even put it in her Jello. People often underestimate the dosage. According to the label it is 2 teaspoons, 3x/day to equal a mere 12% of the daily fiber recommendation. She still gets lots of fresh fruit and if she misses 2 days we start the Mira-lax and if that doesn't work after 2 more days, she gets a glycerin suppository. That usually produces results in a few hours and is a lot easier to manage than an enema. Once she starts going, she keeps going for a few days, and then it starts all over again.

Like your uncle, when she doesn't "move" she gets uncomfortable, will lose her appetite, and get really cranky. It isn't "obsessive" in the least to write all this down. That is important information. It sounds like you have a system that is working well for you (for him). If you can get him to eat more fresh fruit and stewed dried fruit like prunes (add them to the porridge) it may help to reduce the need for the cascara. Keep in mind that anything liquid at room temperature counts as a liquid,,, smoothies, jello, popcycles, as well as the juices, herbal tea.

I know regular excercise is out, but there are range of motion exes and some resistence ones to keep up muscle tone that might help. In my opinion, as long as it is working and he is comfortable, you don't need to change the routine, but if he will eat more fruit that may help. And you could give the suppository a try, to see how that works as an alternative. Then you will know what you can do for the next step if the cascara fails.

You sound like a terrific caregiver. It is good to know you.