I am feeling at a loss for how to approach a discussion of bowel problems with my mother. Suggestions?

An update - first, I was not clear in my original post, that these events happen about 2x/month. As she lives alone (with 3x/day visits from my sister or me or her visiting CG who showers her weekly) and nobody keeps notes, I have no way to quantify the events/details.
Before MD visit, I spoke to her about the issue of constipation - she insists not a problem, though it has been for much of her life. She reminded me she is a nurse and would know if she had a problem!!
Then raised the reality about people putting on gloves to manually remove waste and paper from the toilet - she was very embarrassed, of course. Even when her CG who was present confirmed this issue, she refused to believe it. I asked if it is ok for people who care about her to have to do this task - she agreed that it is ok. I know she doesn't really understand. Then she started to cry, and went over to her CG for a hug and reassurance.
The plan for now is prune juice in the morning. Will see if the CG can get her to drink it - found out that she eats and drinks MUCH more for CG than she does for either of her daughters.
I know it is up to my sister and I to ensure her health and safety as much as we can, within limits of her wishes.
After waiting 90 minutes to see her MD (very unusual, apparently) I omitted this issue from the visit - other topics more important. Lacking UTIs or a trip to ER for disimpaction, I don't think I have enough data to make this a priority.
Thanks to all for their suggestions. Will keep in mind as we go along.

Candy was constipating for my mother. Also you have to be wary of UTIs as they get older and don't wipe as well or wear liners/pads, so might want to incorporate some cranberry juice.

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Can you take her to the Dr and get him/her to raise the topic. Advise from "white coats" is always more readily accepted.

Clairesmum: Imho, you must speak up about this issue to your mother's physician or to her, else you face an expensive plumbing bill.

Your question was actually about how to approach a discussion with your mother. I’d suggest that you do it in the third person: ‘Many people find that….’. ‘It seems that often people find it hard to avoid messes…..’. ‘Have you ever noticed anything like this?….’ Even if it doesn’t get too detailed, it should make it easier when you have to discuss it with the doctor in her presence.

Odd though it seems, some families find it hard to discuss things that seem totally obvious to others. A friend of mine’s grandmother had to be shaved for an operation after she was anesthised, because she had never let anyone see her naked – even her husband! They stripped the necessary bits while covered up in bed!

Will prune juice or prunes work for her? It helps me with my mom to have better bowels. Just a thought.

According to your profile, you are a "Nurse with long experience in elder care in all settings, aging in place, elder abuse casework, mental health and addiction, and hospice. Turned the caregiving I learned as a child into a career." With your level of experience, what would you tell someone else asking this same question, as a third party, with no relation to the patient who's constipated and in this awful situation?

If your mother has 'no awareness of significant constipation' and 'no care about others having to clean up feces on bathroom surfaces, her hands, her clothes, and large amounts of solid matter that is clogging the toilet', I would venture to guess your mother is suffering from one of the dementias which should also be addressed and diagnosed. Once that happens, the doctor can give your family a care plan of action to undertake or a recommendation for placement if s/he feels a team approach is a better idea. You won't be blindsiding your mother if you tell her that it's time for a doctor's visit for a complete and thorough physical. You might even mention that Medicare now requires it on an annual basis, which would be a therapeutic fib to get the ball rolling.

Wishing you the best of luck getting a proper diagnosis for your mother's various issues.

replacing all former underpants with disposable briefs was a godsend suggestion from this forum! It was the only way I was able to get mom to make the switch. She barely asked about them and it became the norm within a day!

This is an ugly and disgusting situation. In a case like this - denial, lack of cooperation, etc., I would explode. I would sit her down and tell her in the most strong, firm words in me that this is intolerable and it is going to stop at once or else. Tell her what the new rules will be and she has two choices - she "obeys" and stops what she is doing or you have had it and will place her. Kindness and sweetness and explanations do not work with people in these situations. You MUST get very tough and make them realize there are serious consequences. Sometimes you get through to them but if not - you stop tending to this "sh1t" and put her some place. No one on this earth should be forced to deal with this. Never.

Clairesmum, ask a colleague for help. I know you don't have District Nurses in quite the same form that we have in the NHS, but you must know where to lay your hands on a specialist continence care, or bladder & bowel specialist nurse to put your mother in front of? These people are brilliant at mentioning the unmentionable and - if you'll forgive me - getting to the bottom of things.

1) take away her underpants and put pull-ups in the place they used to be. You can put liners in them.
2) Follow her to the bathroom. I had to do this with my dad. Turns out he was rinsing and reusing the TP. The sink was next to the toilet. Not good.
3) make sure she doesn't have to fiddle with buttons or zipper to go to the bathroom. Elastic waist pants helped.

4) colored water...dad liked Gatorade, sugar free. He refused plain water. He also would drink more from a straw. I got him a Teva water glass with a lid and a hole for a bending straw.

5) chia seeds in oatmeal, yogurt, pancakes. Normalizes the consistency of the feces. Dad love his pancakes or waffles with whipped cream, banana and berries. If you get toaster waffles, there are high Fibre ones, I think Kashi makes good ones. You can put grated carrots in spaghetti, don't over do it.

6)sugar free candy, Schiff makes probiotic gummed, Activia sugared yogurt.

Toileting was my least favorite chores. 80% of my mealtimes included toileting, dad..

Also, check into how to find placement for her in skilled nursing. Contact adult aging services in your area. That way you can have options. Medicare and Medicare have procedures for this.

I sat down and had a conversation with the people who live in my home that as of last year I am the primary caregiver even though there are 5 other siblings. I care for a 98 year young mother and a 64 year old disabled sister. I explained that cleaning up fecal matter on the toilet, toilet handle and floor is not something I should do with an adult who is capable of taking care of most of her personal hygiene. She denies noticing that she smeared an enormous amount of waste on top of the toilet so I walked her back into the bath room to show her before I cleaned it up, I attend all visits to the doctor and have even scheduled in home visits through her insurance. She lived in her own home up until last year and never left this much of a mess in her house.??? It has not improved but I have addressed it. She dismisses and me. I have a nice home and I'm trying very hard to make it their home as well.......Conversations about cleaning up behind yourself come up a lot. On the water issue.... I asked the doctor to explain the importance of drinking water for better health.... She - also loves sweets. A fresh fruit smoothie contains kale, ginger, carrot juice, bananas, and other frozen and fresh fruit on hand. If I can get her to drink just half of a cup of 8 ounces it helps her digestion. It's understandable that saying somethings might hurt her feelings but fecal waste is bio-hazard. It was difficult to get them to do disposable underwear but I purchased the cute ones in pink, black and purple......... They don't look like diapers they are actually a little sensual. What's on the toilet or her hands can carry to parts of the home where you relax, or even eat,,, Safety First. If they have an accident and she has a couple of times they can now toss it into a red bag and dispose of it. NOT IN MY WASHING MACHINE. Unfortunately My talks have failed and I spend more time cleaning than normal. However, since it's family and I am the primary caregiver for both of them the other option was to get outside help a couple of days a week to help acclimate both them to a healthy way of living without offending or over taxing them,

Finally I placed the washable incontinence pads on the bed under the spread. It's easier to toss a pad into the washer than all of the linen. That's helped a little and has made her more aware of the problem without her getting upset with me for even suggesting better hygiene.... I understand your dilemma but we do what we can for the people we love as long as we can.
Praying and Staying Positive.

I mix up smoothies with juice, spinach, flax meal and yogurt. My husband has a glass of this in the morning along with a packet of Belvita blueberry biscuits and a banana. This keeps him pretty regular. If he has two bananas he will miss a day of BM. Lol

You do not provide us enough information.
Does your mom live alone?
Live with you?
Diagnosed with dementia?
Why is she eating "cookies and candy" and NO FIBER? Who is in charge of her meals / diet?

You MUST tell her sister to see a social worker or medical professional to 'explain' what dementia is and what care is needed NOW. Allowing your mother to have this bowel and feces situations may be considered abuse. She is NOT being cared for as needed.

There comes a time where an adult chid/family member needs to take control as your mother is unable to cognitively, emotionally and psychologically to do so for her well-being.

You write:

"significant constipation that she has no awareness of - but caregivers and family have to clean up feces on bathroom surfaces, her hands, her clothes, and try to clear the large amount of solid matter that is clogging the toilet."

Do you want your mother to live like THIS?
You are concerned about her feelings when feces on her hands ? . . . which will be tracked all over everywhere. She will / may soon have bowel movements in her bed. Then what will you do?

Why are you afraid of your mother and her response to you?
YOU HAVE TO do what is needed for her own benefit. Why wouldn't you want to do this? If you are that wounded / afraid to confront her and do what she needs, someone else needs to 'take charge' and care for her as she needs. Perhaps you cannot psychologically and emotionally manage her care as needed, which seems to be the situation now.

What is the blindsiding about?
She needs professional medical assistance.
Someone needs to be the adult here and she is incapable.
Who is in charge of her well being? You? Another?
Suggestion is that you step up to the plate and put her needs first - and your feelings / fear of her ranting and raving last. She needs care that she cannot provide for herself. This is obvious - isn't it obvious to you?
Gena / Touch Matters

Take mom to see a nutritionist maybe a male doc she may listen to. Also, have bf, lunch… together introduce new foods. Ask doc about vitamin D3, vitamins b12 and k2. Also, go on YouTube and watch Dr. Klaper, Dr. Bernard on Nutrition and u can go to plant based health on line set up appointment on website it’s tele health. Listen to Dr. Charles Stanley of intouch.org .Put God first. God Bless you and your mom

Thanks to everyone for the suggestions. The challenge is that my local sister and her spouse have been caring for her for over 5 years, and don't (yet) seem receptive to the idea of telling her that certain changes need to be made. She has a 'friend' who visits 2x/week for personal care, housekeeping, and errands. Of course my mother doesn't think she needs a caregiver - that what her friend and her daughters are for.
You've given me good strategies to consider, when I see an opportunity to make changes.
I am surprised that she has not yet had a UTI...though when that happens, I will definitely push for changes, if I haven't already been successful.

You can buy and add fiber to her diet just dissolving it in any food or drink. That's what I did for my 97 yr old Dad.

The Caregivers should know what your mom's poop schedule is like every day or every other day, ect.
Et her sir on the toilet a certain time every day or every other day and see if you can have her poop at regular intervals.

Let mom know if she cuts down on water, she could get a UTI and get constipated.

See if mom would wear Adult Pull Ups just at night so she doesn't have to worry about getting up.
Or get her a bed side toilet so she doesn't have far to go.

Her diet and inactivity is a recipe for constipation. Don't get her hooked on stool softeners and laxatives. Hydration is the place to start, if she doesn't like plain water, sweeten it a tiny bit with a product such as MIO, add Benefiber to it, she won't notice. I found my Mom would drink much more if she used a straw.
Cut down on meat and dairy - which are harder to digest, increase with any veggies she likes, and more fresh fruit. Finally a good probiotic at night. You must stress that the caretakers include this protocol if your Mom is in their care for the most part.
A portable bidet such as Luxe, which costs about $45. and is installed under the toilet seat, will help her clean herself without a mess.

Best of luck.

How is her mental state? Is she capable of understanding what is happening and following instructions? If not, it may be best just to discuss this with her doctor as a first step. Does she go to the bathroom on her own, or do people have to help her? And pullups would be much better than liners. There are also disposable pads that can be placed on chairs and under her when she is in bed. Soups sound like a great idea if she will have them.

Is there anything that she likes, that has a lot of fiber? When I go to my Mom's I often bring dinner and include food she likes, but doesn't prepare for herself; spinach, green beans, green peppers, salad, fresh fruit. Mom also takes a stool softener. Perhaps, you could use this as a conversation starter...as we get older our digestive system doesn't work as well as it did when we were younger, so....
My Mom also needs to be reminded to drink. The thirst mechanism in older adults diminishes. I also provide soups that she likes, to provide nutrition and liquid.
Best wishes.

Constipation is either having very hard stool and/or not having a stool at least every 3 days. It appears that her stool is not overly firm if you have to wipe down surfaces. If you are concerned about constipation - given her diet and inactivity - try giving her fiber in gummy form that taste like candy. Start with 1 gummy and increase to 2-3 a day.

It really appears your problem is more about her toileting. Here are a few suggestions:
1 - Get a bidet attachment to her toilet. Then, she is getting "cleaned" every time she uses the toilet. Less mess on her hands and transfer to surfaces.
2 - Put her on a toileting schedule. The idea is to encourage her to use the bathroom every 2 hours while she is awake. She should be escorted to the bathroom if she has problems with walking and/or cleaning up afterwards.
3 - Since she has voiding issues, please have her evaluated by a doctor. People should be able to hold their urine at night. If she can't she may have a UTI, a rectocele (hernia of bowel into vagina which is very common), a cystocele (hernia of bladder into vagina which is also rather common), atrophied tissues of the female reproductive tract which may include her urinary tract, or overactive bladder. I am concerned that she might also have diabetes which can cause frequency. Her doctor can prescribe medication and/or treatment based on diagnosis.
4 - Buy some of the pretty "pull-up" undergarments that feel like fabric. There some that are disposable and some that are reusable after laundering. For some people, Depends and the like are admitting that they are old, feeble, need help, "have a problem"... Whatever preserves her dignity will probably be the best way to go.

I do agree that supplimenting her diet with things that may help resolve the constipation problem would help, You may be able to hide prunes in baked goods, Magnesium citrate will loosen things up (check with Dr. First!), but with either, she MUST drink enough fluids (doesn't always have to be water). Try straws in her glasses, it may be the action, not the fluid that is the problem. Also a pretty glass or container gives visual stimulus. I was told when my father had covid, to get him to drink an ounce every 15 minutes. It adds up. Also a portable bidet (water bottle with directional spray you can find on amazon) would help get her cleaner down there when things are "sticky".

My first thought based on my experience is that she’s going to develop a UTI, soon. When that happens clue the doctor in on her bathroom habits likely being the culprit so he or she (or the nurse) will have the conversation with her. It doesn’t sound like this is something you can have a productive conversation with her about so let the professionals she trusts have it, she needs to be told that limiting her fluid intake is causing more problems not less, that she needs fiber to help her system work and that if she doesn’t help fix things it’s going to become very uncomfortable.

If you have MPOA or HIPPA clearance and are able to talk to the doctor I don’t think this is a situation where you should be concerned about blindsiding your mom. This is not an uncommon issue for the aging patient and even if medical issues don’t point to the need for the conversation they should be able to bring it up simply saying it’s a conversation they have with all their patients with her issues and living at home…or something that effect. This has become a barrier in your ability to keep her where she is and it’s a big risk for causing other issues, like I said I would expect UTI problem so you really can’t wait for mom to be ready to mention it, it needs to be brought up to her and it needs to be addressed. UTI ‘s can be dangerous themselves but constipation that is causing regular backups in the toilet can indicate or become a blockage in the intestine leading to all kinds of pain and problems like sepsis and surgical intervention. You are helping her not stepping on her toes and having her doctor bring it up may very well be the least embarrassing but more importantly the most effective. This isn’t about her caregivers not having to clean up first and foremost it’s about her health. Good luck!

You have to put her on a bowel schedule. If my mom did not have a bowel movement (BM) in 4 days she would be impacted--the stool got so large and hard it would be like a baseball. It would come down to oil enemas and be a BIG mess.

Prunes help with BMs. It is rich in fiber. So does metamucil every night. But her constipation may get so bad those won't help anymore. When that happens, you need to put your mom on a bowel schedule was every Tues, Thurs, and Sundays. Since mom was insulin-dependent diabetic with chronic kidney disease I could not give her milk of magnesia or any kind of fleets so I got the doc to order her lactulose which worked like magic.

Sugarless candies contain sorbitol which is very similar to lactulose. You can try those and see what happens. Mannitol, xylitol, are other examples of sugarless sweets that can induce loose stool.

I think lactulose, which is prescribed, is easiest, and is covered with insurance. Lactulose will not harm kidneys, and will NOT raise blood sugars.

Those indigestible sugars cannot be digested so they go into the bowel and collect water--and turn the stool soft. I started mom with a teaspoon of lactulose but eventually she needed a tablespoon after a few years. Unlike most laxatives, it is NOT habit forming.

Miralax does something similar but it is costly..if you buy that over the counter.

You should be able to to talk to her doctor and your mom about her bowels. Ignoring it won't make it go away.

When mom was able to walk and go to the bathroom on her own--but could not recall if she had a BM or not, I eventually had to put a lock on the flusher since I needed to see if she went! Her bowels were a very lengthy journey of effort which slowly progressed with her Alzheimer's. She managed to live 90 years, 3 months, after 15 years of Alzheimer's and bedridden the last 3 months of her life because I worked VERY HARD to keep her moving. Inducing bowel movements to a bed ridden person is a nightmare, but I did that. She died not from Alzheimer's but the complications of her many other chronic diseases so if she were a walkie-talkie self caring person the same would have happened. Doctors were surprised she lasted that long but she was FULL TIME care and the moment I woke up to bedtime she requires constant CARE. She died with perfect skin, two years of hospice, she did end up with a feeding tube which is a LOT of care in itself but I never had a single problem with it because i did not want her to die of dehydration which can take weeks. To the end she was comfortable and never require a single narcotic or psychotropic even with the most advanced Alzheimer's.

Miralax is tasteless and can be mixed in drinks or some foods like yogurt. You need only to determine the right dosage to achieve regularity. (You do not need to use a whole packet or the full amount suggested on the bottle.) Treating constipation is more of an art and part science. Keeping a daily record of bowel movements on a calendar also helps. Depending on the daily results you may need to reduce or skip a day, or increase the amount of help. Also, you to give it a few days to work.

Base on one of your comments, mom is living alone and shows signs of undiagnosed vascular dementia? She should be taken to a neurologist and diagnosed. At the very least take her to get PCP and insist they do a mini mental test to see where her cognitive level is. You need that to know where she needs to be moved to.
Since she lives alone, there is no way to help change what she eats. Metamucil would be could to help her bowels but would she be willing to mix and take it.
I know you will say she wants to stay in her home and refuses to move. They all say that. But she doesn’t have the executive function to make rational decisions in her best interest. Either you hire caregivers to help with the cleaning, dosing with Metamucil and get her to drink liquids and eat fruit during the day or you move her to where she can have more eyes on her. It is a sad reality but here you are.

Since she likes sweets, give her prunes. But soak them in water first to soften them and then cut up them into small pieces to be sure there aren’t any stones inside. Then be ready for the messes when the prunes accomplish their mission.

Do you think she should be living alone?

Is her doctor aware of these issues?

This is why an abused child should not take care of the elder who abused them.

Replace mom's underwear with adult incontinence briefs. Accompany her on all trips to the bathroom.

Placing her may be the kindest thing you can do.