Mum's bowel incontinence particularly bad right now, any advice plse?

Discussion in 'Middle - later stages of dementia' started by AlsoConfused, Dec 12, 2013.

  1. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,953
    Several days this week have been horrendous for Dad (he's had 3 washes on the go in a day) and upsetting for Mum (who won't remember why Dad's so fed up but gets very stressed because he is).

    Are lapses from the previous levels of incontinence to be expected please in mid-late stage dementia? Is there any source of expert advice (eg incontinence nurse or GP) you'd recommend who might be able to help get Mum's incontinence problems back under control?

    Mum's been bowel incontinent for around a year. She's now got used to wearing incontinence pants.

    Mum's not a compliant patient and part of the incontinence problem is the extreme difficulty of getting Mum to go to the loo at regular intervals.

    Constipation has been a chronic problem and Mum's on lactulose (dosage is "tweaked" as required to suit her needs - there's no obvious reason to adjust the dosage at the moment). As far as Dad knows, Mum isn't unwell (she has UTIs very often). Mum's now been on memantine for around 8 - 12 weeks.

    The only non-family help Dad gets is a morning carer to get Mum up and give her the morning pills and someone to do the ironing for them. My own feeling is that we're getting to the limit of Dad's ability to cope with Mum at home; I think he's not quite ready to accept that yet. Dad's 88, he's got bad arthritis virtually everywhere it's possible to get arthritis.
     
  2. clareglen

    clareglen Registered User

    Jul 9, 2013
    318
    Cumbria
    He's doing well. I wonder if the new meds are affecting her bowels in combination with the lactulose. I also have a mum who has to take laxatives and it always ends up like this. Her doc said if she gets diarrhoea like this then she has taken too much laxative but if she doesn't end up having 'a mess' she doesn't feel like 'she's been enough' - dementia kicking in there. Your dad will need more help, can't imagine doing what we have to do at the age of 88.
     
  3. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,953
    clareglen, like very many carers Dad's doing the best he can, at a dreadful personal cost. While he wants to carry on we're doing our best to support him ...

    Does anybody happen to know which healthcare professional is his most likely bet for help with this problem? I'd have thought the incontinence nurse and / or the GP (Dad can't get in touch with either immediately - unsurprising but he's feeling overwhelmed right now).

    We've many lovely photos of Mum. She was exceptionally beautiful (still is very attractive when content and clean) and has been a wonderful Mum and wife. All this is so sad.
     
  4. nitram

    nitram Registered User

    Apr 6, 2011
    19,142
    Male
    North Manchester
    The continence nurse is probably the best person unless the frequency is too short in which case the GP as there may be another problem.

    You don't mention consistency of stools, if this can be seen - difficult with pads - it might help the nurse/GP

    You should be aiming for a high 3 or 4

    http://www.sthk.nhs.uk/library/documents/stoolchart.pdf
     
  5. yeehaken

    yeehaken Registered User

    Jan 5, 2014
    3
    Hi
    I think that perhaps if you approach the GP one he can look at your mums medication and she's some light on the reason and two he may also be able to point your father in the right direction in which to gain more support before he gets too ill to cope at any level
    I have to commend him on doing what is doing but at his age he deserves more support
     
  6. FifiMo

    FifiMo Registered User

    Feb 10, 2010
    4,710
    Wiltshire
    When you say the bowel incontinence has changed do you mean she is having loose bowel movements as opposed to her usual constipation? Constipation is a recognised side effect of memantine see attached leaflet...http://www.merseycare.nhs.uk/Library/What_we_do/Clinical_Services/Pharmacy/Memantine 2011-final.pdf.

    A couple of things come to mind...could she have had a change in diet eg over Christmas season that might have involved food that is now too rich for her? Does she perhaps have the stomach bug that is going round right now?

    I think if it was me I would start with the GP to get a review of what is going on. Incontinence nurse can quickly become involved at request of the GP.

    The whole caring roles is fraught with challenges and is not something that one person can cope with on their own. Each carer has their own tipping point where they know they have reached the limits of their endurance and incontinence is right up there at the top of the list of things that cause this to happen. I know if it were me that this would be my limit. I know also that it was a major factor in my grandfather admitting defeat when he cared for my grandmother who had dementia. You might need to have this type of discussin with your dad. Also, speak to him about whether having say, a maximum of 4 carer visits a day would actually help. 4 visits only account for around an hour a day so your dad would still be carrying the burden of care. 4 visits might work to cover things like taking meds or preparing a meal but it is not something that can help when bowel movements can be extremely variable. It is not like your dad would leave her sitting in a soiled pad for the next few hours until a carer arrived to assist.

    The only suggestion I have is whether your dad could emulate the routine of a care home where they take residents to the toilet in, say, hourly intervals and do this irrespective of whether you think she needs to go or not.

    Having said all this, it would not relieve the other toll on your dad with regards to the increased laundry alone! This the leads you to the unspoken question...is it perhaps time for a Carehome where they take over all the physical work but leave your dad free to do what he really wants...to spend quality time with his wife.

    Very hard issue to deal with and ope they get the help they need in order to provide some support for both your mum and your dad.

    Fiona
     
  7. geordie

    geordie Registered User

    May 11, 2010
    108
    we used lactulose successfully for some time but have now been prescribed a different medication which has some stimulant effect in addition to softening agent.
    Might be worth discussing with GP.
     
  8. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,953
    Belated thanks for your advice.
     

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