Severe Constipation in Elderly Woman

[Vicki__0__0]

  My 84 yr. old grandmother suffers from severe constipation. She
  has a very large incisional hernia from aortic anyserysm repair done
  7 years ago.  (It was repaired with mesh once and ripped out again).
  She cannot have surgery to repair it again because she has another
  anyserysm and also heart blockage (she had triple bypass surgery
  7 years ago also).  
  She also has severe osteoporosis and multiple spinal fractures;
  she is in severe pain all the time.  She takes morphine and darvocet
  by pill for the pain; which adds to the constipation problem.
  (She's taken darvocet for about 18 years now, but has been on
  the morphine for just a month or so).
  She takes Citricil, Gas-X, stool softeners, etc; but is still
  chronically constipated.  The hernia bulges out and is hard with
  stool and interferes with her breathing.  
  Any suggestions will be greatly appreciated!
______________
Dear vickie,
There are severla different methods to improve your grandmothers constipation.  You are correct that the pain killers are conastipating.  Avoid these medications as much as possible is the first suggestion.  Second, I would increase the amount of fiber in your grandmother's diet.  Although fiber causes gas, if you take enough, there is often a good response.  If your grandmother can not ingest enough fiber because of gas, bloating etc, she could try Lactulos.  This sweet liquid contains a nonabosrbable sugar that causes diarrhea.  I generally start patients on two tablespoons twice a dat and double the dosage every two or three days until I either reach 16 tablespoons a day or the desired bowel pattern is obtained.
Despite these efforts some patients still suffer from constipation.  In these circumstances there are two options.  You could administer Fleets enemas or tap water enemas per rectum every few days to stimulate defecation.  The last approach, that I have used for patients with neurologic diseases, is to administer varying dosages of Golytely, aliquid that flushes the intestine.  The dose administered is determined by trial and error.  One warning: Golytely is very bitter and patients hate taking this liquid if it is given too often.  It does however, represent a very effective treatment.
Best of luck.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet you and to review your history in greater detail. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of intestinal disease by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: constipation
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