personal hygiene with toileting

FLGARose

My LO (83 yrs.) with moderate ALZ has been having increasing problems with managing her personal hygiene with her bowel movements.  She has been wearing depends reliably, which has helped at least some.  She's sloppy when she removes them (irritated I think), and makes a mess in the bathroom.  I will find, and clean, fecal matter around the toilet, on the tiles, floor, etc.  She sometimes forgets to flush; sometimes she will come out of the bathroom with soiled pants because of the sloppiness.  When I ask her to change because of this she gets annoyed with me.   She will dispose of the worn Depends in the trashcan in the bathroom about half of the time; sometimes it ends up on the floor elsewhere. 

My questions:

1)  I was thinking of having an automatic sensor flush toilet installed.  Does anyone have any recommendations on this front?

2)  Does anyone have any similar experience and/or coping advice?  Right now, these challenges with toileting are the worst (most burdensome) of her symptoms.  

Thanks. 

Rick4407

Hello Rose.  I will add some comments though some may not be possible for you.  My DW is bowel incontinent, I watch her very closely and am familiar with her schedule so I know when to start expecting a BM.  I assume that you are not in a position to monitor that closely.

 I would recommend a bidet toilet attachment.  Ones that have heated seats as well as warm streams of water are a real work saver.  They are available from Amazon for around $250-300. 

 If you have any control over her diet you may be able to lean toward "low residue" foods and away from concentrations of fiber.  That's assuming she does not need fiber for other issues.  

In my reading bowel incontinence is usually associated with stage 6, you may want to check on her other "losses" of skills.  Rick

harshedbuzz

Sadly, she is no longer able to manage this ADL independently and will be needing assistance in the bathroom.

CanyonGal

When using the toilet, my issue has been more aligned with wiping the wrong direction after a bowel movement which sets up an environment for a UTI. When the stool is formed it is not so much an issue, but loose stools create a bacteria environment for many health problems (UTI, rashes, skin issues). Washing hands is a must.

To me, it would be even more a problem if the stool is contained in the Depends. I think the processing problem is the main issue, where the dementia person can't retain the wiping procedure, or any steps beyond taking off the Depends. So, there will be messes, unless assistance is provided or nearby in the restroom or wherever you are changing the Depends.

Sometimes, the dementia person doesn't think the Depends is that "dirty" and continues wearing them! 

One technique I observed in LTC, the aide would put on new pants after removing the Depends if they were dirty. The bowel movement was somewhat predictable, and she would wait to change her clothes using the bathroom as a changing room.

Pairing up bathing routines to clean up excess has been used in some situations. Most of the time having wipes nearby for the aide to do a "last" wipe has helped. But assistance is required, and I have seen my mother use her restroom without an aide. It is a frustrating experience.

Ci2Ci

1. I'd be concerned about an auto-flushing device, in case she put non-flushing items in the toilet -- a very likely possibility.

The toilet bidet attachment mentioned is a great idea, in general. [I love my $35 attachment.] The concern would be 1.) her being able learn and sustain a new skill; 2.) her not getting it in the off position correctly, and it leaking water. Could end up with a huge water bill, very quickly. If you wanted to give it a try, perhaps also order some kind of water usuage alert meter -- like one that will send a notice to your smartphone of abnormal use. (I'm assuming that she lives alone?)

Another new skill to learn, but: if you could keep a container of plastic grocery sacks in the bathroom, and teach her to place one open on the floor at her feet before sliding off the Depends directly into the bag, first. Then, tying closed that bag to throw in garbage. ...A simpler idea might be getting a diaper genie, and teaching her to put the soiled Depends into that container. 

Best of luck. A challenge.

FLGARose

Thank you for the feedback.  We have modified her diet, and it's helped some.  But, not entirely.  I appreciate your comment on the symptom relative to stage.  Although she's been diagnosed with moderate dementia, she still has the ability to consistently recognize and name others; can keep up with date/time--with calendar reminders around the house, and she still walks about 2 miles in a very structured safe outdoor area with her dog every day. (She wears a tracking device so we can monitor her location.)   We've helped her for some time with IADLS because she's not driving, etc.  But, the main challenge right now is her hygiene--associated with a worse stage.  It's all a bit maddening. 

Again, thank you. 

FLGARose

Thank you for the helpful feedback.

FLGARose

Thank you for the feedback.  Yes, we've already had some issues with her flushing her depends down the toilet.  We have a small trash can with a hook with plastic bags close by for refills. I made a small sign on the wall with a reminder of where to dispose of the depends.  She took it down multiple times, so I gave up.  I do appreciate the idea of plastic on the floor while changing.  I think she would be too stubborn to do this herself, but it's still a good idea if I or another have to help her change--at least to help with less cleaning/disenfecting the bathroom floor.  Of course, we (and others) would have to ensure there is some fall prevention protocol in place.

Thanks again. 

harshedbuzz

FLGARose wrote:

I appreciate your comment on the symptom relative to stage.  Although she's been diagnosed with moderate dementia, she still has the ability to consistently recognize and name others; can keep up with date/time--with calendar reminders around the house, and she still walks about 2 miles in a very structured safe outdoor area with her dog every day. (She wears a tracking device so we can monitor her location.)   We've helped her for some time with IADLS because she's not driving, etc.  But, the main challenge right now is her hygiene--associated with a worse stage.  It's all a bit maddening. 

A couple of thoughts around this. Most PWD do go through the loss of skills in a very similar manner, but it is also not unusual for someone to straddle stages where they mostly function at once level except for one or two behaviors/symptoms from the next. Incontinence hit dad earlier than I'd anticipated given how verbal he was. My friend had her mom at home and was very attentive to a toileting schedule with mom who lost all her English and had very little purposeful speech in her first language long before she needed Depends. 

A person is generally considered to be in the latest stage for which they have any of the characteristic symptoms/behaviors. My mom had a rather rosier view of dad's disease progression as she focused on what he still could do. I was more pragmatic and always staged him further along. 

HB

PS this scale is a useful one for staging. It considers the behavior you describe as a sign of stage 6c. 

Functional Assessment Staging Tool (FAST Scale) for Dementia (compassus.com)

FLGARose

Thank you.

Linda_Miami

Unfortunately the only way to prevent this from happening is for someone to assist her in the bathroom every single time.  There really is no other solution.

Sorry that I dont have better news.

Anon1001

I agree, the only realistic solution seems to be to have someone accompany her to the bathroom every time she has to change her diaper due to a bowel movement.  If she resists, you can have her lie down on a bed, and then change it for her there; it may be uncomfortable for her to walk to a bathroom with a dirty diaper, and she may not like having to change it herself.  If she only has to lie down on a chux, and roll once on her side to allow you to remove the dirty diaper, wipe/clean her, and put on a clean diaper, she may be more cooperative.  Make it clear that she will not have to do anything, or handle her dirty diaper or try and clean herself up.  I hope this helps