Looking after your bowels in hospital

Regular bowel movements are essential for a healthy body. There are lots of things that can affect how easily this is maintained. Diet, hydration, regular movement, health conditions and medication can all cause changes in your bowel habits. Being in hospital impacts all those factors and can often lead to problems with bowel movements.

We talked to geriatrician, Dr Liza Lau, about how to look after your bowels in hospital.

“Older people are very susceptible to becoming constipated,” Dr Lau tells Bridge. “They may not realise they are becoming dehydrated, and often don’t drink enough fluids for a range of reasons. When they’re unwell, appetite drops off, so fibre intake can be on the low side, especially if they rely on a ‘tea and toast’ diet.”

If an older person needs to go to hospital, the risk of constipation is high, and this can lead to faecal impaction if left too long and not recognised. For some surgeries, the patient needs to be nil by mouth (no eating or drinking) before the procedure, which can add to dehydration.

“Opioids and other medicines can compound the risk of constipation, so I always remind staff to prescribe laxatives or stool softeners to help counteract this,” says Dr Lau.

Correct toilet position with raised feet, leaning forward with a relaxed tummy to allow the muscles in the pelvic floor to relax and the bowels to open without straining.

Why does constipation happen?

“Some people find it hard to tell the signals from their body, of needing to go to the toilet, and end up getting more and more constipated,” Dr Lau explains.

“One thing we try to work on, is to rebuild awareness of when they need to go, to help them get out of this cycle.”

Going to the toilet to do a poo is a coordinated process.

When the rectum (where poo is stored) becomes full, nerves send signals to the brain that it is time to go to the toilet.

Once on the toilet, leaning forwards with the feet supported and the tummy relaxed can help signal the pelvic floor muscles and anal sphincter (the ring of muscles that keeps the poo in) to relax, allowing the poo to pass more easily.

If this signal is missed or delayed, the urge to open the bowels may pass, making it harder to go later. This can cause people to strain on the toilet because the natural coordination and timing of the body have become disrupted.

On the other hand, if there is overflow diarrhoea, this signal comes so suddenly that there is not enough warning for the person to get to the toilet in time, resulting in faecal incontinence. This can be really distressing for both the person and their carer.

What should you look out for while your loved one is in hospital?

People with dementia or communication difficulties can easily develop faecal impaction if they do not realise they have not emptied their bowels, cannot communicate discomfort, or cannot tell staff when they last opened their bowels. This is where family, friends and carers can make a big difference. It helps to know what is normal for that person — emptying their bowels every 3 days might be normal for some people, while 2 to 3 times a day might be normal for others.

Signs of constipation to look out for:

• no bowel movement for 3 or more days
• hard, dry or pellet-like stools
• straining or sitting on the toilet for a long time with little or no result
• abdominal pain or discomfort
• a swollen or bloated abdomen
• reduced appetite, nausea or vomiting
• agitation, restlessness or other unexplained behaviour change, particularly in people with dementia who may not be able to communicate discomfort
• changes in bladder symptoms, such as urinary accidents, sudden urgency, difficulty passing urine (wee) or difficulty emptying the bladder
• a very full rectum can sometimes press on the bladder or affect bladder emptying. This can contribute to urinary symptoms, particularly in people already at risk of urinary retention, such as some men with an enlarged prostate.

Diagnosing constipation: how to advocate for your loved one

If you think your loved one may be constipated, here are some checks you can ask their healthcare team about:

• checking the hospital chart for a record of bowel movements
• a physical examination of the abdomen to check for stool build-up, bloating or tenderness
• a clinical assessment, which may include listening for bowel sounds if there are concerns about obstruction, ileus or reduced bowel function
• further assessment or investigations if symptoms are severe, unusual or not improving.

Carers play a valuable role by noticing concerns, reporting changes, and asking helpful questions; while the healthcare team determine which examinations or investigations are appropriate based on the clinical findings and specific situation for the person.

Things you can do to help with constipation

Movement: Walk around the ward if safe and approved by the health care team.

Food: Ask the nursing staff or your loved one what they have been eating. If they don’t have much appetite, check they have no dietary or swallowing restrictions and then bring their favourite food from home. Being unwell can slow the bowels, so fibre-rich foods such as prunes, pears, fruit or veggies can help maintain bowel regularity.

Drink: Even if they are on IV fluids (which don’t pass through the digestive system), drinking fluid is still important to help keep stools soft and prevent constipation. Check with the nurses that they have no medical restrictions (nil by mouth, need to limit fluids or difficulty swallowing) and if safe, make sure to keep a drink bottle with a straw within reach to make it easy for them to keep drinking regularly.

Routine: Try to maintain the person’s usual bowel routine while they are in hospital. Some people may be sent home with an individual bowel plan that includes one or more medications. Macrogol (Movicol) an osmotic laxative or docusate sodium (Coloxyl) a stool softener both soften the poo, while a stimulant laxative such as senna helps the bowel muscles move poo along. These medicines may be used alone or together, depending on the person’s needs. The medicines, doses and duration should be tailored to the person and reviewed as their mobility, diet and symptoms change but will often have to be taken for several months after being severely constipated. People with reduced mobility or neurological conditions (stroke, Parkinson’s disease, spinal cord injury) may need a longer-term bowel plan.

Also in this edition

• Carer of the Year
• Mad about materials
• Finding a group to support you
• A day in the life of someone with neurogenic urinary retention
• What is neurogenic urinary retention?
• Disabilities: talking to your GP about incontinence
• Is health advice from TikTok or ChatGPT better?
• Alcohol and incontinence – what’s the connection?