Bad constipation in elderly mum in hospital - any suggestions?

[littlewon]

Mum in her 80s in hospital on heavy opioids due to pain from multiple fractures. These really help with her pain but causing chronic constipation (which she has had for years at home but gets even worse each time she stays in hospital on pain meds).

She has been given all the normal constipation meds including heavy doses of movicol, senna, lactulose, laxido, and she has also tried flaxseeds, prunes, orange juice etc but nothing seems to really help and just cause her to be very bloated and have a lot of trapped wind. They are resorting to enemas which are uncomfortable and seem quite drastic. Any suggestions? She is getting very frantic about this now?

Tinned pears might be helpful, they would be soft-ish to eat for your Mum but ought to work well. Worth a try…

Opiods, slow down the motion of the stool, and allow more fluid to be absorbed via the large bowel, causing the stool to dry out and become fixed in place.

So, in order to compensate, she needs to increase her fluid intake to counteract the impact of the opioids in the bowel (this will NOT impact on the primary action of the opiods in reducing pain). Essentially, this is what enemas do - introduce more fluid into the bowel to soften things up and get them moving. Enemas just come at it from the opposite end of the large bowel.

If she is underweight, it is important to make sure the fluid contains calories (e.g. juices, milk, etc. Jelly also technically counts as fluid). It might be worth asking the nursing staff to refer her to one of the acute dietitians in the hospital, for their input. The nursing staff should also be monitoring her fluid intake each day, to make sure it is high enough.

Two kiwi 🥝 fruit a day is a fairly well known tip.

Magnesium powder

I have had horrendous impaction over the years
Magnesium better than anything

Porridge, prunes, stewed fruit, vegetable soup, a proper dose of lactulose, 15 or 20mls every evening, adding a small dose of a stimulant laxative as well and loads of fluids. Can she do any sort of mobilising? Abdominal massage specifically for constipation can be very effective. You work round the large bowel in the direction of travel, so from the lower right quadrant (her right), up, along the transverse colon and down the left side. Start with sweeping strokes, then small circular strokes, finish with large circular massage. I used to do this for cancer patients to keep things moving.
It is hard to describe, but there must be a you tube video.

Dried pears are 10x the fibre if tinned but hard to find in regular supermarkets.