Why is my mom, 80, with CKD, having bowel incontinence?

Question

Hi doctor,

My mom is 80 years old with CKD stage 5 on conservative treatment. But past few days, she has been having inconsistent bowel movements, and she passes stool while gassing also. Have tried Loperemide for three days, but no relief.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

In an 80-year-old with chronic kidney disease (CKD) stage 5 on conservative management, the new onset of fecal incontinence with passage of stool during flatus is clinically important.

A few points to consider:

The various causes in elderly CKD patients:

Age-related weakening of anal sphincter tone.
Diarrheal illness (infective, antibiotic-associated, or secondary to uremia or medications).
Constipation with overflow incontinence.
Uremia itself can sometimes alter bowel motility.

Since you have used Loperamide, and there has been no benefit after three days. This strongly suggests that the problem may not be simply a hypermotility-related diarrhea. Continuing it without knowing the underlying cause may not be safe in advanced CKD.

What you must do next is:

Give a detailed medication history. Some drugs used in CKD patients, for example, phosphate binders with Sorbitol, antibiotics, or magnesium-containing laxatives, can worsen diarrhea.
Stool examination: This is done to rule out infection or blood.
Review of bowel habits: This gives baseline data for constipation or diarrhea, frequency, and urgency.
Neurological assessment for any recent changes: Any weakness, confusion, or prior stroke must be noted.
Supportive measures until reviewed:
- Ensure good hydration (This has to be adjusted for CKD status).
- Dietary review and carefully avoid excess laxatives.
- High-fiber foods if diarrhea-predominant.

I hope this helps answer your query.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com

For now, you can give her probiotics. Since I do not know what medicines she is on, it is not advisable to take medicines without full knowledge. For the time being, you can give tablet Rifaximin 200mg thrice daily and Vizylac (Lactic acid Bacillus) thrice daily. Consult your specialist doctor and discuss with him or her before starting the medication.

Meanwhile, you can fix an appointment by clicking on my name and scheduling a consultation.

Hope this answers your query.

Thank you.