Why is my 68-year-old mother’s constipation getting worse?

Question

Hello doctor,

My 68-year-old mother has been dealing with severe constipation for over a year now, and it is getting worse every month. She only has bowel movements once every five to seven days, and when she finally goes, it is so painful she cries.

Her gastroenterologist did a colonoscopy, which was normal except for some hemorrhoids from all the straining. She takes Miralax every day and senna tablets, and even tried magnesium citrate, but nothing helps consistently. The problem started after she had a hysterectomy for uterine fibroids, and I think something got messed up during surgery.

She is also on Oxycodone for her back pain, which probably makes the constipation worse, but she cannot function without pain medicine. Her stomach gets so bloated and hard that she looks six months pregnant, and it hurts to touch. Tried increasing fiber and water, but that just made her more bloated and gassy. She also takes calcium supplements for osteoporosis, which the doctor said might be contributing.

Are there prescription medications that work better for chronic constipation?

I am really worried because she barely eats anymore since she feels full all the time.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

This is a pain, as it affects her daily routine and also her health. The treatment she is taking should have helped her, but I feel her stools are getting hard because of the medicines she is on, and also the supplements. Too much fiber, if not digested, can cause her some bloating. I suggest a combination of therapies.

As one week has not passed, her stools can worsen her hemorrhoids (swollen veins in the anus or lower rectum, caused by increased pressure from straining, constipation, pregnancy, or prolonged sitting, leading to symptoms like itching, pain, swelling, and bleeding) and prolapse. She might have frequent bleeding, which might lead to anemia and weakness. Suggest that she take a combination of the treatments. Giving her an enema every two days till her stool frequency improves can help. Hope the gastrosurgeon had some inputs to give.

Fiber supplements increase weight and lead to mass in passing motion. This helps, but can have digestive issues.

Osmotic agents like milk of magnesia are good, as they increase the water content in the feces and lead to better motion.

Stool softeners are better, as they soften the hard stools, making them easy to pass. Good to use them daily.

Lubricants, such as mineral oil, also make the process of passing stools free and reduce the strain.

Stimulants can be taken in combination with softeners and lubricants so that the stool gets removed with ease, and she does not have to struggle. Take her to a gastrosurgeon. They will also have an answer. Need to check if any other cause is there for this severe constipation.

Encourage her to eat as if she eats, and she will get her required nutrition. The loss of appetite can be due to psychological stress from having difficult motions. Take her to a psychologist who can counsel her, and she might be able to pass stools better.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.