Jul 27, 2018

Can Constipation Kill a Person with Alzheimer’s Dementia?

When constipation occurs in people with Alzheimer's or another type of dementia it can become dangerous and life threatening.


Can Constipation Kill a Person with Alzheimer’s Dementia?
By Rita Jablonski
Alzheimer's Reading Room

Constipation is an uncomfortable annoyance for most people.

Early in my nurse practitioner career, I practiced in internal medicine. I was asked to see an elderly patient with dementia because she had "diarrhea." Her breath smelled like poop. She had vomited before coming to the office.

I was shocked to feel a hard, almost rock-like, abdomen. My exam revealed a constant trickle of watery poop. This was not diarrhea.



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I realized that she had a life-threatening blockage in her gut and sent her to the emergency room.

She had to have surgery to remove a huge blockage of poop. 


She died shortly afterwards. The blockage had stretched the gut so far that it tore. Poop and bacteria had spilled into the abdominal cavity and caused a massive infection.

I gently explained what happened to her family.

She had a large blockage in her intestine. The gut tried to fix the blockage by constantly squeezing to get the blockage out.

Picture a huge traffic accident, where only one lane of traffic slowly snakes around the pileup. The contents in her intestines started to back up, much like traffic will back up behind the accident.

She had started to vomit feces, which is why her breath smelled so terrible. 


Her family had unknowingly made the problem worse by giving her diarrhea medication, which slowed the gut even more.


Causes of Constipation


Not Enough Fluid in the Gut

Sometimes, people just don't drink enough water. Some people drink a lot of water, but they take water pills (diuretics). This causes water to leave the body.

In warm weather, people lose fluid from sweating. No matter the cause, not enough fluid is a problem. Water is needed to keep the poops moist and slimy, so that they keep moving through the gut. Without enough water, the poops become hard and slow down in the gut. Slow poops can eventually get stuck.

Not Enough Fiber

Fiber is found in fresh fruits and veggies. Picture the gut like a giant tube of toothpaste, and the gut squeezes in sections to move the poops. Fiber causes the gut to squeeze and move the poops along and out of the body. If the diet is low in fiber, the gut does not squeeze as often or strong enough to move the poops, so the poops slow down.

Medication

Some medications, like certain pain medications, can make you feel sleepy and slow. These same medications can put the gut to sleep. A sleepy gut does not squeeze the poops and move them out of the body.

Holding It In

The gut can stretch, more than the bladder. If I have to pee and I try to hold it in, eventually, I'm having an accident. The bladder can only stretch so far before it over-rides my desire to hold the pee in. The gut, however, has much more stretch to it.
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Five Ways to Fight Constipation in Persons with Dementia


People with dementia have to be watched for constipation. They are at risk for dehydration, not eating enough fiber, taking binding medications, and holding it in.

Make Them Drink

Dementia is more than forgetting dates and facts. Dementia affects thinking and doing.

Many people with dementia may tell you they are not thirsty. Many people at the moderate to severe stage may forget how to pick up a glass and drink.

If you are caring for someone with dementia, it is not enough to have the glass of water sitting in front of them. Every hour or so, pick up the glass and place it in their hands and make a "drinking" gesture. Or even better, sit with them for a couple of minutes and drink your water while giving them theirs.


Push the Fiber

Just like people with dementia may deny thirst, some will tell you they are not hungry.

Some develop a preference for sweets and skip the veggies. One factor is that people with worsening dementia forget how to use utensils and may sit and stare at the plate. Totally unsure of what to do.

This is the time to serve finger foods like grapes, carrots, and tangerine sections. Prune juice is another fan favorite. You can also dissolve psyllium (e.g. Miramax) in 6-8 ounces of liquid to sneak in some fiber. Just follow the directions for mixing.

Watch the Medications

Every time you take the person with dementia to a health care provider, ask, "Are these medications necessary?"

Many medications can cause constipation, so be alert when starting a new medication. If the person with dementia needs the medication, and constipation is a possibility, work on pushing the fluids, the fiber, and daily exercise.

Schedule Toilet Time

Do not wait for the person with dementia to tell you they have to go. It may never happen, or may be too late.

Even in later stages, people with dementia may hold in the feces because they are confused and not sure where the toilet is located. I've seen situations where caregivers keep changing the undergarments but never sit the person on the commode.

Without the feel of the toilet seat, the person with dementia holds in the feces. This is why you sit the person on the commode a couple of times a day, usually after eating.

MOVEMENT!

Walking around helps the gut to move, too. Physical activity is so important for many, many reasons. Now you have another one. Physical activity helps to prevent constipation.

Red Flags


It helps to pay attention, maybe keep a record, of the person's bowel movements. If the person is not pooping, and you notice vomit that smells like poop or constant trickling of liquid poop from the rectum, contact your health care provider immediately.

Please Note: In my practice I had 4 people living with dementia die from the ill effects of constipation. It can happen. The goal of this article is simple and straight forward - I don't want this to happen to you.

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Rita Jablonski, PhD CRNP is an internationally recognized expert in dementia behaviors. She is tenured professor at the University of Alabama at Birmingham and a funded researcher, with over 50 publications and book chapters to her credit. Rita blogs at  Make Dementia Your B*tch. She offers caregivers coaching and guidance for caregivers at DementiaCentric Solutions.

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