Toilet problem, denial and aggression

Discussion in 'I have a partner with dementia' started by Prospector, Aug 23, 2015.

  1. Prospector

    Prospector Registered User

    Sep 30, 2014
    61
    Trowbridge, Wiltshire
    Every few months my wife forgets to remove her knickers when using the toilet. The problem is that she denies the need for cleaning and fresh clothing. I approach the topic gently and tactfully, explaining that I understand it's not nice for her and that she may feel embarrassed. However, despite this I face increasing agitation and then aggression as I try to get her clean, and I end up having to force her into the shower or bathtub to clean away any solids. She often accuses me of getting some kick out of cleaning her up, and I explain that I really wish I didn't have to do it, but that it needs to be done.
    On the positive side, she usually calms down quite quickly once back in clean clothes, but it is very stressful and leaves me feeling down.
    Does anyone have any suggestions on how I might be able to handle things better? I find that official advice from books and websites rarely tackles issues as tough as this.
    Thanks.


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  2. Tin

    Tin Registered User

    May 18, 2014
    4,826
    UK
    Sometimes mum does this, but not as often these days, I think her problem was that she would stop after pulling down tights thinking they were her knickers. I stopped her wearing tights and bought black underwear so she could see that they were still up and knee high stockings just to break the habit of a life time with tights and knee socks for Winter. Also these days I have to go into the bathroom with her, just to make sure she has pulled everything down before sitting on the toilet, I have to remind mum to go to the toilet every few hours now and I follow her in with an excuse like need to clean my teeth or check towels are clean.
     
  3. Tiller Girl

    Tiller Girl Registered User

    May 14, 2012
    91
    I've not come across this yet with OH but I would be following him to the toilet if I had to.

    I do follow him to the shower as he struggles with that but I usually stand outside the door and shout instructions but then if I think he's struggling I go in.

    It's one of those situations where you're probably going to have to try different things. The suggestion from Tin about the tights sounds a great idea to start with.
     
  4. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,654
    North West
    Not a great job at the best of times and I'm sure you don't need the aggro on top. Good job it only happens rarely - at the moment.

    I think it's worth trying Tin's approach though this may well cause great offence as she will believe that she's perfectly capable without your help as, of course, she is - most of the time. She probably doesn't remember the accidents. I'd be inclined to do this a few times and just see if she gets accustomed to it.
     
  5. Prospector

    Prospector Registered User

    Sep 30, 2014
    61
    Trowbridge, Wiltshire
    Thank you for the comments. My wife hasn't been wearing tights all through the summer and I can't imagine getting her back into them now - pyjama trousers are difficult enough. She hasn't worn daytime trousers for a few years either, but I think we may have to get her some for the winter. It will be worth trying to ensure a colour contrast with her underwear though.

    If it were just the cleaning up that would be OK, though not a nice task it needs to be done. It's the denial, aggression, resistance and accusations that are so hard to take, even though I know it's the AD and not my lovely wife.


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  6. Long-Suffering

    Long-Suffering Registered User

    Jul 6, 2015
    426
    Hi Prospector,

    I think you are actually handling things very well; you are calm and kind and get the job done. I think the only improvement that you can really make is not to beat yourself up about it. I know that is easier said than done, but what I've learned from looking after my dad is that it's necessary to be prepared for the aggression and accept it if and when it does arise. My dad always forgets very quickly afterwards, and it sounds like your wife is the same.

    So I would suggest the best thing for you is to try to come to terms with the situation as it is instead of looking for some "better" way to control your wife's behaviour, b/c often with dementia that isn't realistic - the situation doesn't get better, it's just that we learn to cope better.

    Best of luck,

    LS
     
  7. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,780
    Salford
    I had exactly the same problem with my wife but it wasn't every few months it was once or twice a day. I had a mop and bucket upstairs and another one down stairs as she'd just do it where ever she was. It all stopped and the mop hasn't been out of the bucket for 6 months. The day they decided the Donepezil probably wasn't doing anything and took her off it (and the Citlopram was stopped too) it hasn't happened once. Toilet time can still get a bit messy but at least it's confined to the toilet these days not every room in the house, the car and in one case Morrisons supermarket.
    K
     
  8. MrsPuff

    MrsPuff Registered User

    Aug 23, 2015
    5
    I hear where you're coming from, Prospector, I sometimes wander if the people who write these 'self-help' books on dementia actually have any idea about how to care for someone who doesn't want to be cared for :(.
    Might be worth looking into incontinence pants, even if your wife isn't 'really' incontinent - of course she'll still need occasional cleaning up, but it should deal with wetness and odors for the time being (meaning less immediate stress), and you might have better luck if you can pick and choose the best possible time to clean her.
     
  9. Leswi

    Leswi Registered User

    Jul 13, 2014
    120
    Bedfordshire
    Mum now gets confused most times about pulling pants down, she does trousers Ok but unless I follow her to toilet pants generally get forgotten. My answer is to follow her into toilet and casually mention pants are in the way and help with them. She responds OK to that but if I am not there and she makes a mess she does get agitated with dad. Dad can't really be bothered with following her however many times I explain it is necessary. Sometimes I wonder about not putting on pants at all as a way of solving the issue but not gone down that route yet!
     
  10. Prospector

    Prospector Registered User

    Sep 30, 2014
    61
    Trowbridge, Wiltshire
    Thanks all. Interesting comment from Kevinl about donepezil. My wife is officially on a doctor-approved trial period without it (after 22 months) due to the tendency to loose bowels and diarrhoea, which just made her highly susceptible to UTI. I'm not convinced it ever did anything to help her, but stuck with it as it's supposed to delay the progression of the disease (how do they prove that?!). In practice she had weaned herself off the donepezil anyway as it was getting very difficult for me to persuade her to take any medication at all. Forcing it down is not an option!

    Not sure about the incontinence pants. I can't imagine persuading her to wear them just yet, and in all fairness, toilet misses have reduced recently (donepezil again?). This incidence was forgetfulness rather than incontinence. I can also imagine that following her to the toilet could provoke agitation, so need to be very careful on this. I also know that she gets distracted if I ask her anything about using the toilet just as she's about to go.


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  11. Spamar

    Spamar Registered User

    Oct 5, 2013
    6,969
    Suffolk
    #11 Spamar, Aug 23, 2015
    Last edited: Aug 23, 2015
    A few points that come to mind:

    When OH has periods of incontinence, we saw the continence nurse, who checked fluid in and fluid out. I found that stopping coffee ( he had it strong and sweet) after about 18:00 worked wonders for a few more months. He was still on donepezil at that time.

    His problem, often was getting to the loo but not having time to pull down pants. A urine bottle helped, especially at night.

    Showers - mistake I made when doing up the house was not to have shower controls outside the shower. He forgot how to use controls to get water at preferred temperature, then forgot how to turn them on or off.
    I would have to get him undressed, get shower to correct temp, then remind him what to do. Then hope the water would do it's work, Then go back and help him to dry himself.

    For some time I helped him dress, merely by handing him things, in correct order, ready to put on. It really annoys me when I see people not doing this, but allowing caree to get it wrong day after day! Doesn't help them or you!

    Hope some of this helps.
     
  12. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,780
    Salford
    I can go with this, several time a day due to clues from how it is in AZworld I ask my wife "would you like to put some clean knickers on?" Somewhere in her head that means going to the toilet so I give her the clean ones (even though the old ones aren't soiled or wet) and she goes to the loo, job done.
    As Sparmar says if you give the clothes in the right order with a clear instruction then that's a piece of small information that can be processed, giving someone a pile of clothes doesn't really work.
    K
     
  13. Casbow

    Casbow Registered User

    Sep 3, 2013
    994
    Colchester
    Toilet problem

    I feel very sorry for the trouble you are having with your wife. I think trying to keep your partner clean and tidy is one of the most difficult things that we as carers have to deal with. My husband is becoming more and more unable to know when he needs the toilet and it causes so many problems. He doesnt understand that he has to sit on the toilet resulting in the obvious mess, which he then will not keep still while I clean him.I feel like a prisoner in my own home as until he has been to the loo I am frightened to take him out. Perhaps you could get disposable pull-ups for your wife which can just be removed and maybe try baby wipes to clean her down there.Flushable toilet wipes are brilliant although need to be flushed one at a time. So sorry for you. I know how awful it is, good luck.
     
  14. Prospector

    Prospector Registered User

    Sep 30, 2014
    61
    Trowbridge, Wiltshire
    Thanks again for all the suggestions and sympathy. What is very clear is that each person affected by dementia is unique, so I need to pick out what might work best for my wife.


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  15. bobmc

    bobmc Registered User

    Jan 29, 2014
    13
    Ilkley
    My wife also has a problem remembering to remove knickers, interesting that some people have found that the problem disappears when they stop taking the donepezil. Why did they stop taking the donepezil? Is it safe to do this? I do wonder whether taking all these different tablets may be exasperating the problems!
     
  16. Prospector

    Prospector Registered User

    Sep 30, 2014
    61
    Trowbridge, Wiltshire
    In my wife's case she had been taking donepezil for nearly two years and it tended to give her loose bowels and diarrhoea. As her personal hygiene diminished, this has recently caused her to suffer repeated urinary tract infections. The doctors agreed that the effect of the UTIs was far worse than any benefit from the donepezil.
    Effectively, my wife weaned herself off the donepezil in a disorderly way, as during the UTIs, she would often refuse to take the medication, becoming very agitated and aggressive. I could not persuade her to take the donepezil, and using force is no use.


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  17. Spamar

    Spamar Registered User

    Oct 5, 2013
    6,969
    Suffolk
    #17 Spamar, Aug 29, 2015
    Last edited: Aug 30, 2015
    Hi
    OH was on donepezil, but didn't have diarrhoea, rather the opposite! Though that was long standing, well before Mr. dementia came calling. Anything like diarrhoea turned out to be constipation with overflow.

    The saing, prospector, is, if you've seen one person with dementia, you've seen one person with dementia. Everybody's different. Things appear at different times, in different orders.
    I tried to get a basic knowledge of what might happen and what I would do about it and waited to see if that symptom ever did turn up. Be prepared, I think it's called!

    Certainly, in the early days, a certain symptom would appear and, after a while, I would complacently say to myself, ah yes, can cope with that. Then 2 days later something else happened.....

    Keep smiling!
     
  18. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,780
    Salford
    In the context of the discussion Spamar that's one hell of a Freudian slip:D
    K
     
  19. goodtotalkC

    goodtotalkC Registered User

    May 2, 2015
    7
    Forgetting how to use toilet

    I really feel for you......My OH has just started not to realise when he needs to go to empty his bowels. Not sitting down etc unless I remind him. He hates `getting in a mess` Could this be that he is simply putting off the `evil moment`hoping it will all go away. He frequently says ( after all the cleaning up) that he is `Never , ever going to do this again _eg have a p..!) He is going to have to `go away`....... does anyone know?- Can an incontinence nurse help with this? I will have to resort to pads I suppose. Can it be a start of an infection ??
     
  20. stanleypj

    stanleypj Registered User

    Dec 8, 2011
    10,654
    North West
    You can ask your GP to refer him to the continence service goodtotalkto. Hope they're better than ours - providing in adequate pads and pushing laxatives. The mess could cause infection but not if cleaned up thoroughly which I'm sure it is.
     

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