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Nursing Homes Abuse Blog By Jonathan Rosenfeld

Failure To Monitor Bowel Movements In Nursing Home Patients Can Lead To Impacted Bowels

Posted in Impacted Bowel, Sepsis, Wrongful Death

In addition to monitoring food and liquid intake of nursing home patients, staff need 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 of 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.  It was 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 (also referred to as: severe sepsis, sepsis infection, septic shock, severe sepsis, septicemia) 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 generally unhealthy diet with high fat and processed foods.

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, many nursing home patients are highly 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 patients 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

Annals of Internal Medicine – Incontinence in the Nursing Home

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  • Linda

    I wouldn’t put my dog in a nursing home. My mother is in one due to late stage Alzheimers and is only there because she can’t be managed at home.
    My father was recently placed in skilled nursing facility after a hospital stay for dehydration. PRN meds were a part of the doctor’s orders. On day 8, my father began having dellirum. We made an issue of it and were concerned. The staff told us he was fine and we were overreacting.
    We noticed severe shaking, thirst and mental confusion. The staff was contacted by his physician and was told he was fine. 8 hrs later, he was septic. IN fact, by the time he arrived at the hospital, he was in septic shock. He survived. The doctors claimed after several failed attempts to find the site of infection that it was pneumonia.
    However, at the time he was released from ICU, they did a scan and found he had a serious bowel impaction. My father passed away 30 days later. BTW: his bowel movements were never monitored while he was in skilled nursing and records show he was never given PRN meds for constipation.

  • lk

    We went through the same thing….my brother was constantly being under-hydrated. He was listless, gasping for breath, and out of it. When in the hospital – on several different occassions – he would come to life when they hung an IV and got fluids into him. We constantly asked that his fluids be monitered and he be given enough…… No such luck….Recently he was running a low grade fever. Blood work and urine tests were going to take 2 days to get results back. We made the decision – over and above the objections of nursing staff – to have him taken to the ER. The doctor found that his bowel was so impacted that his intestine was near bursting !! There seemed to be an infection and he had to have a surgical procedure done to correct the problem. He could have gotten septic, too, and died. When we presented this to the Nurse Administrator, she said that the impaction happened overnight – not over time as we were saying. Stay on top of administration…..they lie, chart to cover themselves, and look to save the dime at the expense of your loved one. IF you find problems, don’t do as we did and wait…..REPORT it to the State. We reported, and the inspector asked why we waited so long……the fear of intimidation and threats is real to patient and family….but, stand up for what is RIGHT and the safety of those who don’t have a voice. Don’t be silent

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