Hygiene question (warning - TMI)

May flowers

Ok, I tried to search on this but I didn’t see anything very specific and I kind of need specifics on hygiene for someone who is uncircumcised. My FIL is dealing with his 3rd UTI since January and currently going through treatment. 

I know from searching that we should be retracting and cleaning the foreskin area. The hospice nurse did not have an answer so I’m reaching out to y’all. DH and I are not sure exactly what that entails. Do we use soap and water, water only, some other cleanser? Do we do it every diaper change or once a day? 

harshedbuzz

A quick google search brought this up from Australia-

Foreskin care - Better Health Channel

Is the doctor prescribing his antibiotics for UTIs aware he has an intact foreskin and examined it to determine if there is an issue with it? Where his urine samples cultured so the appropriate antibiotic is being prescribed? There are certain foreskin issues that could increase the likelihood of a UTI or it could be that he's on the wrong medication and it has nothing to do with the foreskin at all. 

May flowers

HB, thank you for the link. Neither the doctor nor the nurse has examined him. I will make sure they know about the foreskin. No culture either. I asked for a culture for 3 weeks after the first treatment failed and we were sure it was back,  but they just treated him instead with a different antibiotic. I feel that the problem is the nurse did not want to cath him to get a urine catch.  

Then there is a prostate issue, for which he was on Tamulosin but it made him bonkers - delirium and crying out all night long. We even tried cutting the dose - same thing.

We may have to switch hospice providers. I like our case manager nurse but she isn’t the one visiting. I do not feel our concerns are getting passed along to the doc. 

ButterflyWings

May flowers, I do not have direct experience with this (intact foreskin that is)... However, if I were you, I would (and do) clean him at least with a wet adult wipe after every toileting, without fail. And I change the tabbed brief that’s closest to his body if there is any dampness at all. DH wears a pull-up over that, to keep it all together mainly. He usually gets about 1/2 of urine in the toilet; his brief catches the first half. He will not shower or bathe so - a sponge bath only routine is additional motivation for me to do this hotspot maintenance faithfully.

After gently but thoroughly washing him, I use a light film of protective ointment on his penis every time, and we periodically use Nystatin ointment. And my DH is circumcised. However, 3 UTIs-ish in less than a year, followed by a yeast infection that went from 0-60 mph in the blink of an eye—-taught me more than I ever imagined needing to know and do, to care for that sensitive part. 

Who knew that men can get yeast infections too? (I didn’t), and it was something I NEVER want him to experience again. The fungal infection (yeast) did not respond to the bacterial infection (UTI) meds. And in less than 48 hours from the first minor sign, we had a full blown 911 emergency on our hands. I kid you not. 

The ER doc said another 24 hrs would have required surgery, to “re-circumcise” him, essentially And that’s after the Dr had to quickly research “balanitis” to figure out what he was seeing—which I was able to suggest to them due to input from this priceless forum. M1 called it. I am so grateful for this community, for so many reasons. Don’t worry about TMI. This crew has just about seen and done it all. Or will, in due time. lol

Anyway, that’s our experience that I hope your LO never has. Good luck! The extra minute of that routine each toileting has been 100% worth it.

Joydean

Buterflywings, what protective ointment do you use? 

May flower, thank you for this question! I need answers to the same question. 

Nerdyblond

Hi Mayflowers...I wish I had a direct answer but I agree that possibly a flushable wipe or witch hazel or warm water and an antibacterial soap maybe?? They need to make mini dishwashers for those "things", yea?

May flowers

Butterflywings- thank you for the detail. It’s clear I have to pay more attention to the parts. I use the zinc cream on his bottom, is there a different ointment for this? I haven’t been putting any cream down there because I didn’t want it to stay moist under the foreskin. I have been using the wipes on it but I had not been retracting every time. 

The nurse coming today to cath him will be checking things out.

I told my DH when I was cleaning my FIL carefully in the shower last night - that this was top of the list if things I never thought I’d be doing. My FIL said, “me either”. I’m glad for the moments of humor, I tell ya.

harshedbuzz

Mayflowers-

After reading the previous posts, I suspect there are those who are unfamiliar with foreskin care and should maybe sit this one out.

Ladies, this tissue is the same kind as you would find on your own labia minora or lining your mouth. You need to use the gentlest of methods here. I would avoid wet wipes (parents diapering intact infant boys are advised to avoid these as well) unless you have rinsed them off very well. I would avoid alcohol, witch hazel and antibacterial soaps. Most docs suggest something very mild like unscented Dove. 

If your FIL has a urologist, perhaps he could make suggestions. Pediatricians are another source of penis-care, but most diapered kiddos do not have a retractable foreskin so they're protected from feces. 

HB

ButterflyWings

May flowers and Joydean, 

I use the “alcohol-free, pre-moistened StayDry disposable Washcloths” ordered by his nurse for this purpose. The package says “with aloe & vitamin E”, “DO NOT FLUSH” (my DH tested that one and I had not yet started going in after them which I will not hesitate to do now, if necessary. Yes it did contribute to a clogged toilet later that day.) 

It is super important to wash your hands well afterward. I’ve been warned about encountering or spreading the yeast, if any, and things like infectious diarrhea etc to the caregiver easily. 

Hospice provided lots of (*disposable non- latex) gloves as well as the OTC “Skin Protectant Ointment” in a 4 oz tube. The ingredients panel says 93.5% white petrolatum. Inactive ingredients: Corn Oil, Light Mineral Oil, Vit A Palmitate and Vit. D. (So I learned something today: it is glorified basic Vaseline). Lol. It works.

Nystatin requires a prescription for it & when yeast is observed. But the gentle cleaning routine    I described has kept any problems at bay for 6 mos. Until his recent MC respite stay when he wore the same Depends for 4 days until it finally overflowed. Moist, warm environment for days...? I’m not happy with their lack of prompting and assisting him to avoid that, obviously. So, we are managing the aftermath and it’s clearing up with resuming the routine I described.

HB is correct to sound the alarm! Please no astringents, harsh soaps etc! I like the idea that if you wouldn’t use a product in your mouth, don’t use it on his sensitive part/s. We use nothing stronger than water and the no- rinse liquid on these special wipes, which I still rinse/dilute before using it on DH’s body—but only water ‘down there’.  

Now I’m remembering we did get a perineal spray in the generic hospice kit for that area should he need it but I’m only familiar with that product from the post-partum days of trying to manage my stitches after childbirth. We use these disposable washcloths exclusively for DH’s  and if you rinse it, please still only use it once, as instructed on the package (says Do Not Reuse).

May flowers thank goodness you and your DH can laugh at the things we do for love or our PWD LOs!

harshedbuzz

ButterflyWings wrote:

HB is correct to sound the alarm! Please no astringents, harsh soaps etc! I like the idea that if you wouldn’t use a product in your mouth, don’t use it on his sensitive part/s. We use nothing stronger than water and the no- rinse liquid on these special wipes, which I still rinse/dilute before using it on DH’s body—but only water ‘down there’.  

I'm sorry if I came off as harsh as lye soap. 

A little clarification-- it's the lining of the foreskin that is mucus tissue. 

Nerdyblond

Great to know harshedbuzz... I declare you to be the knower of all things related to hygienic caregiving! (I'm kidding...I wouldn't want that title. I got a case of Robin Williams syndrome from caregiving stress. I'm very random). Thank you! I am not there yet with my mom but we're going to put her in a home so maybe I won't have to, but I can pass all this on to people I know who are caregivers against their will.

Joydean

Mayflowers, thanks for the laugh! It’s great that your fil has a sense of humor about him! 

Butterfly wings thank you for sharing the good information. The things we never thought we would have to learn about! 

Olly_Bake

MayFlowers, just checking in on you and your loved one. I read that hospice was not successful with the foley. So what did hospice decide or did the issue resolve itself? I'm hoping it was the issue resolved itself.

May flowers

Thanks for checking in, Olly… the issue has not resolved - he is still flooding the bed at night but every diaper the last two days has had almost no urine (but he is having bms). He is drinking between 50-60 oz of liquid/day (mostly water)

The hospice doc prescribed a different medicine - Alfuzosin - since he can’t tolerate Flomax. I’ve never heard of it (fingers crossed). I’ve read a little about it - the biggest concern might be it lowers blood pressure. His BP already is low.