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Dad has moderate to severe vascular dementia and has been living at the equivalent of NH at the VA for several months. I visit every month and I am here for 2 weeks. Today, he was having a severe problem with an incompletely expelled, very hard, BM. At home he was used to being reminded to drink copious amounts of water. He does not seem dehydrated, however from personal experience I know that clear water can sometimes help the situation. Here is not allowed clear fluids due to aspiration risk, because he is not always mindful when drinking. Nurse wants to add stool softeners to his medicine regimen "except for when he is loose". These take hours to work, I'm thinking more water might be better, but he is not dehydrated, just want to avoid more medicine especially one with unpredictable timing. I imagine it is quite uncomfortable for everyone should an aging man defecate in his drawers. I am wondering if milk of magnesia which is a mild laxative, would work better. It doesn't seem to be available to the nurses. Yesterday he knew exactly what dose he needed and how often, because apparently he's had this problem before when he was home, and I know they won't try to follow his own medical advice. Seems more water and an occasional gentle laxative might work better than a regimen of stool softeners. He does not appear dehydrated, but my personal experience says drinking water helps, regardless. Not sure he can be trusted or capable to drink water alone in his room. Maybe they could have him drink a full glass of water as part of the morning and evening medicine delivery system. Does anyone know the ins and outs of this issue as it relates to a sort of nursing home? SS vs laxative vs just getting enough water. Also the ins and outs of calling plain old H20 medicine! Thank you.

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Just add a half of teaspoon or even less of ground Flaxseed in water or juice or sprinkled on food and everything comes out smoothly, without troubling other conditions. Using just a pinch of flaxseed daily also has health benefits: similar to fish oil and then some.
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This is awesome information, all of it. I've forgotten the exact one he's taking, but Miralax was in there somewhere. The advice about the system slowing down is a brilliant new concept for us to remember, and electrolytes have always been an issue, had no idea that was related to the amount of water you drink, maybe that was part of one of his initial problems, he would shake uncontrollably and it was generally helped with electrolytes. Now that he's not getting as much water, it is quite possible that's why I haven't heard of him having (or seen myself on this visit) having a shaking problem. You are wonderful people and this is a wonderful support group!
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My mother suffers from vascular dementia. Her overall motor function is declining, hence the constipation. Nothing over the counter works to get her bowels moving. Ask the doctor to try Lactulose. Google this to learn more about it. It's a prescription-based syrup/medication. It's not expensive, like less than 20 dollars for a one month supply. Suppositories only work when the stool is stuck in the rectum/sigmoid colon area. Motor decline affects the entire digestive track, the entire abdomen, which is why the stool is overall moving slowly.
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My Mom takes 1/2 cap of miralax with a glass of V8 every day.   It doesn't thicken and has no flavor.   We use V8 only because she like the taste and it had some vitamin K to offset the warfrin and keep her INR in balance.  (Kill 3 birds with one stone)

She has IBS, and everything needs to keep moving or we end up in the ER again.
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Is there still an immediate problem? - because there are enemas that would help with that, although you would need to ask qualified nursing staff to supervise.

I'm with you on the drinking enough water; but you really don't want to overdo it, especially if his kidney function isn't great, or you'll mess up his electrolyte balance and run into all sorts of problems. Judging "enough" is the tricky bit!

Unless he's taking medication that bungs up his gut - codeine and iron supplements are the usual suspects - he shouldn't need to rely on laxatives all the time. As he's on thickened fluids, I assume there's a swallowing reflex issue? But all the same, raisins can be puréed with his breakfast oatmeal, for example; and surely most of the foods that prove useful in "keeping you regular" can be mashed or puréed and mixed in.

I also accidentally discovered that Heinz Cream of Tomato soup will go through some people like a dose of salts. It all gets a bit technicolor and I would not recommend this technique.
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I'm on my way out the door but I wanted to chime in... there are so many threads on here with advice about constipation so you might want to search the site and read them. Personally I would start with the simple tried and true, more fluids, prunes or prune juice, more fiber (but only if you can be sure he is getting enough fluids).
Miralax (PEG 3350) daily was truly a miracle for us, at least for a while. Stool softeners (colace) can also be added. Usually the next add in is senna (various brands), M of M is not really considered a gentle laxative but worth considering before moving on to the big guns. Good luck.
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Stool softeners are harmless and won't hurt him.

It is not a laxative.
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Mil had severe severe bouts of being constipated she had Alzheimer's hard to get her to drink enough fluids and eat right only wanted sweets : (. Old country doc recommended prune juice slider. Which is prune juice with melted spoon of butter worked like a charm every time for her
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It sounds like he's not drinking enough water and he's probably very constipated. If this has been going on for a while, he might need a little help with some laxatives as long as it's not impacted inside of him and hardened to the point it won't come out. If it is, he'll likely need medical intervention if it's that bad. Not drinking enough water will definitely do lots of damage and you can't live long without any water. Not drinking enough over a long enough time will start taking it's toll on the body. What he needs to do is to drink lots of water and not necessarily Coldwater if he's constipated. Lukewarm to warm water actually helps to soften your bowels and help them pass more easily. One thing that would also help if he likes hot soup's is to serve him hot soups and other warm beverages to help soften things up, but lastly he definitely needs lots of water. The human body needs about 64 fluid ounces a day but it's often hard to drink that much but it is possible. I knew someone years ago who lived on tea and coffee until she got a kidney infection and had to cut way back and start drinking water. The kidney infection I guess healed up because I never heard no more about it. One thing you really want to remember is not drinking enough water can lead to a multitude of other illnesses and complications. I found that there is a link between drinking plenty of water and rarely ever getting sick with the cold or flu. I haven't had a flu shot since 88 and never really needed one since then. My secret is making sure I stay hydrated and as much as humanly possible, I avoid sick people. When it does hit me which is rare, I always make sure to stay hydrated and eat a proper diet as much as possible. One friend of mine I currently visit also drinks plenty of water, we both like ice water but simply because neither of us get sick and find ice water to be very helpful in keeping internal swelling at bay. If you ever get a UTI, definitely go for the ice water for sure, it shrinks internal swelling. What would help in getting enough water is to start using a 64 ounce water bottle or even a 64 ounce thermos. With there being a wide variety of drink containers on today's market, you're bound to find something you like. I'll give you a clue. Having a transparent 64 ounce water bottle will help you to monitor how much you've drank that day since the body needs 64 ounces each day in order to function at its peak. Drinking enough water mains you not only feel cleaner internally but you're also more energetic
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The best thing I have found is a good, natural probiotic (keeps the good bacteria in your stomach, which alot of meds deplete). Also, a good, natural fiber supplement. Hope that helps!
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