Managing Bowel Focus and Fixation in Elderly Dementia Patients

Understanding and Managing Bowel Focus in Seniors with Dementia

As dementia progresses, seniors often develop an obsessive fixation on bodily functions like bowel movements. While disconcerting for caregivers, this common behavioral symptom stems from underlying neurological changes requiring patience and compassionate care solutions.

Why Bowel Obsessions Develop

Dementia damages areas of the brain controlling inhibition, impulse control and social appropriateness. Simultaneously, memory loss and disorientation give rise to anxiety producing a mental desire for control. Combined, these factors can manifest as frequent bathroom visits, repetitive bowel complaints or continuous passing motions.

Bowel obsession surfaces from a subconscious attempt to anchor one’s self amidst the uncertainty of cognitive decline. Monitoring bowel habits introduces a consistent activity stabilizing an increasingly chaotic world. Seniors leaning into this obsessional habit do so for psychological relief, not malicious intent to frustrate others.

Communication Challenges

Impaired cognition also hinders communication skills in those with dementia. Sufferers often cannot convey discomfort, pain or changing elimination needs effectively. Lacking proper vocabulary and descriptive detail, requests for frequent bathroom trips or bowel complaints serve as the best verbal approximation able to be mustered.

Additionally, dementia affects one’s ability to interpret social cues from others accurately. An annoyed glance when asking to use the bathroom yet again may convey irritation to a healthy individual. That regulatory feedback gets missed by a dementia-affected brain, prompting repetition of what sparks a response - in this case, another bowel complaint.

Managing Bowel Fixations

While often bewildering, seniors’ obsessional habits require understanding. Creating a care environment facilitating proper elimination helps ease anxiety fueling continual bathroom visits. Recommendations include:

• Maintaining a fluid bowel movement schedule via diet, fluids, activity and possibly laxatives
• Logging details like timing, frequency, amount and consistency of movements
• Identifying triggers making accidents more likely
• Allowing bathroom independence until safety becomes impossible
• Employing orientation cues like signs on bathroom doors
• Using relaxed, distraction-based redirection when obsessive requests occur
• Seeking medical advice to address painful bowel issues potentially underlying fixations

Caregivers must also prioritize self-care to manage feelings of frustration. Support groups allow sharing coping strategies while counselors help process complicated emotional dynamics.

Common Bowel Changes in the Elderly

Aging and medical issues contribute to various bowel changes in later life. Understanding typical alterations helps identify root causes of fixation.

Constipation

Constipation constitutes infrequent, difficult passage of dry, hard stools. Contributing factors include:

• Dehydration
• Low fiber diets
• Medications
• Low mobility
• Diseases slowing transit
• Ignoring urge to defecate

Treating underlying causes, increasing dietary fiber, exercising more, establishing a bowel routine, drinking fluids and possibly taking laxatives helps manage constipation.

Diarrhea

Frequent passage of loose, watery stools signifies diarrhea often stemming from:

• Bacterial or viral infections
• Irritable bowel diseases
• Medication side effects
• Artificial sweeteners
• Small intestinal issues

Identifying and eliminating infection triggers, adhering to the BRAT diet, avoiding dairy, taking anti-diarrheal agents, and treating health conditions improves diarrhea.

Fecal Incontinence

Inability to control bowel movements manifests when:

• Rectal storage capacity decreases
• Pelvic floor muscles weaken
• Mobility issues prevent quick bathroom access
• Cognitive impairment inhibits urge response
• Neurological diseases develop

Bowel retraining, pelvic exercises, prompt bathrooming, wearing protective undergarments and sometimes rectal bulb stimulation can aid continence recovery.

Medical Causes of Bowel Fixations in the Elderly

Various diseases contribute to difficult, unpredictable bowel habits possibly underlying fixation. Common age-related conditions include:

Irritable Bowel Syndrome

IBS involves chronic, relapsing abdominal pain with irregular bowel habits. Bouts of constipation or diarrhea occur due to hypersensitive nerves overreacting to typical gut funcioning. Stress exacerbates IBS requiring symptom management using diet, antispasmodics, antidepressants, probiotics, peppermint oil and psychotherapy.

Inflammatory Bowel Diseases

Chronic idiopathic conditions like Crohn’s disease or ulcerative colitis cause intestinal inflammation. Symptoms include abdominal pain, bloody stools, severe diarrhea, weight loss and bowel fixation trying to control unpredictable symptoms.

Colorectal Cancers

Slow-growing colorectal tumors can obstruct intestines or create abnormal connections causing erratic bowel habits. Bleeding, pencil-thin stools, anemia, fatigue and unexplained weight loss accompany dangerous cancers necessitating diagnostic scoping and tumor removal procedures.

Gastrointestinal Infections

Bacterial, viral or parasitic gut infections lead to inflammation disrupting normal absorption and transit. Salmonella, C. difficile, norovirus and giardia infections require diagnosis and targeted antibiotic treatment to restore healthy bowel functioning and appetite.

When Bowel Focus Progress to Dangerous Size

While innocent at onset, obsessional behaviors sometimes evolve hazardous dimensions. Diaper changes and clothing soiling from fecal smearing causes local skin breakdown. Insisting on public bathroom use introduces fall risks and indignities. Complete loss of inhibition results in fecal handling and throwing also contaminating living space.

In rare cases, bowel obsession graduates to coprophagia - purposely ingesting feces - raising serious health concerns. Though repellant to observers, compassion regards this as the nadir of someone’s loss of reason through no fault of their own. Their humanity still deserves upholding, especially amidst the darkness of such desperation.

Securing Necessary Medical Input

When bowel focus spirals beyond manageability at home, psychiatric and medical guidance proves essential. Preliminary workup includes:

• Physical exam assessing for obstruction or fecal impaction
• Neurological testing to evaluate sensory perception
• Stool studies checking for underlying infection
• Colonoscopy to visualize tumors or strictures
• Psychological evaluation assessing mental competency and safety risks

Once fixable medical issues get excluded, psychiatrists can prescribe medications or recommend programming in a specialty memory care facility to help control extreme bowel fixation.

Supporting Elderly Loved Ones Struggling with Bowel Obsessions

When conservatively managed bowel focus spirals into a damaging fixation for elders and their caregivers, compassion must lead the response. Though profoundly difficult, remember:

• This behavior originates from neurological disease - not conscious choice
• Expressing disgust, anger or ridicule only further harms their dignity
• Their inner world remains full of confusion and fear
• Efforts to over-control fixation often backfires
• External supports networks can reinforce your stability
• Compassion for them and yourself paves the only healing path through

Dementia presents behaviors leaving caregivers shocked and demoralized if unprepared to view them with grace. But even darkest, dirtiest habits reflecting a disease’s brutal progression cannot erase the beautiful person once residing behind that shell of fallen humanity.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.