Monitoring resident bowel movements can save lives

In addition to monitoring food and liquid intake of nursing home patients, staff needs to pay attention to the elimination of the wastes. When urine and feces are not produced on a regular basis, nursing home staff must bring these problems to the attention of physicians.

One of the more obvious cases of nursing home neglect my office is working on involves a patient who went at least 10 days without a bowel movement. Shift after shift, the nursing home staff tended to our client—yet no one cared enough to look at his medical chart to see when the last bowel movement occurred. Not until the man was taken to a local hospital was it determined that the man’s bowel had become impacted with feces. Within 24-hours of his admission to the hospital, the man died from complications related to sepsis.

What is an impacted bowel?

An impacted bowel is the condition where feces are trapped in the lower part of the large intestine, causing a waste obstruction. The stool collects in the bowel and becomes hardened. This hard stool can irritate the rectum, resulting in the production of mucus and fluid which can leak, causing fecal incontinence.

One of the most common symptoms is lack of appetite caused by pressure on the abdomen. Hemorrhoids (a mass of dilated veins in swollen tissue around the anus) are a common sign of impacted bowels because it is more difficult to rid your body of fecal matter. Other symptoms include: a constant feeling of fullness, diarrhea, hardened feces, cramping and pain, vomiting, constipation, bad breathe, and bloating. If left untreated, the waste obstruction can cause a rectal infection that can lead to sepsis or death.

The most common cause of impacted bowel symptoms is Crohn’s disease. In a nursing home setting, causes of impacted bowel include: not drinking enough water, not eating a diet with adequate fiber, lack of activity, certain prescription medications, and a generally unhealthy diet with high fat and processed foods.

Treatment/prevention

When timely identified, impacted bowels can be treated with a higher fiber diet, increased hydration, exercise, laxatives, enemas, suppositories, or manually removing the hardened feces.

Unfortunately, nursing home patients are susceptible to impacted bowels due to a combination of inattentive staff and an unhealthy lifestyle. In order to minimize the chances of impacted bowels among patients, nursing homes should:

· Provide the residents with proper nutrition (sufficient fiber, water, and healthy foods), the residents can suffer from painful constipation.

· Provide as much physical activity as feasible for patients.

· Monitor each patient’s bowel movements (time, quantity, consistency).

· Pay special attention to patients complaining of stomach pain or cramping.

Resources

Article Click – Fecal Impaction vs. Constipation

The association of fecal impaction and urinary retention in elderly nursing home patients