Caregiver Skills for Managing Fecal Incontinence in Middle and Late Stage Alzheimer's
Fecal incontinence affects many people who have Alzheimer’s disease. It can occur at any stage of Alzheimer’s disease, but is more common in middle stage and very common in late stage Alzheimer’s. There are caregiving stratagies to improve and, in some cases, eliminate bowel incontinence. Here’s How
Exclude Diseases That Cause of Fecal Incontinence
Remember, people with Alzheimer’s can get sick too. Fecal incontinence may just be a symptom of an underlying health problem and will require evaluation by a doctor and appropriate treatment. Examples of symptoms that require medical investigation include; blood and or mucus in feces, weight loss, changes in bowel movements (e.g. diarrhoea or impacted faeces), infection, excessive wind, pain.
Fecal incontinence can be caused by many diseases or conditions. These include; medication side effects, recent surgery, infection, trauma, cancer, diseases of the bowel such as ulcerative colitis, Crohn’s disease, diverticulitis.
Diet Can Contribute to Fecal Incontinence
Diet should be rich in fiber but not to the point where it causes diarrhea. A balanced diet is important to maintain health and efficient bowel movement.
Behavioral Treatment for Fecal Incontinence
Fecal Incontinence in people with Alzheimer’s is often due to a combination of factors. Once disease has been excluded as a cause of their incontinence you can then begin to investigate the causes. Central to your investigation are improving effective communication and trying to limit the impact of confusion due to Alzheimer’s disease. Physical problems that result from limited mobility and exercise, long periods of bed care, inadequate diet, poor fluid intake will also affect toilet programes and fecal incontinence.
Establish a Baseline of Current Toilet Behavior
Keep a diary of their current toileting habits for at least 3 days (7 days is best) before you begin to make any changes. Do an ABC chart.
A=Antecedant-in other words, their behavior leading up to the incidence of fecal incontinence. Record time, where they were, what they were doing, saying, if they asked to use the bathroom, became restless etc.
B=Behavior-where, how they were incontinent, who they were with, etc
C=Consequences-what happened, as a result of the incident of fecal incontinence. Their behaviour (agitated, calm etc), what they were talking/saying etc.
Also record the time of any normal bathroom trips and other bowel movements. From this diary you will be able to see any patterns in behaviour and can give clues to how any new interventions can be best programmed into their day and cut down or eliminate incidents of fecal incontinence. The program you establish can then be continued on inother settings such as day care centers, on visits outside the home, in respite care and nursing home facilities.
Keep your diary to refer back to establish whether a new behavioral toileting programme is effective. A new toileting pattern should show results after a couple of weeks.
Behavioral Treatment Program for Bowel Incontinence
Begin your timed toilet trips every 2 hours. You can use your baseline recording (diary) to work out the best times of day e.g. after meals, at bedtime.
Factor in any regular toilet trips you have established before with good result. Always take them to the bathroom if they ask to go.
Help Minimise Confusion During Bathroom Trips
Orientate people with Alzheimer’s. For example," Dad I’m taking you to the washroom. “Mrs Bouldon we are at in the bathroom now, try to go”. Be reassuring. Try to maintain dignity by giving some privacy. Do not keep them in the bathroom or on the toilet too long. Praise any positive results. Reassure the person that their behavior is appropriate.
Improve your communication! Talk with a soft reasurring tone. Remember that many people with dementia require frequent redirection.
Never shout or hurry them. Talk to them with respect. Allow privacy whenever possible.
Important Bathroom Trip Rules!
Keep to as rigid a timetable as is practicable. Because you are targeting fecal incontinence you will be able to change the amount of trips to the bathroom once you establish the best toileting programme for that individual. This program will also radically reduce the incidents of urinary incontinence too. Every one’s a winner!
Night toileting should be maintained on a regular time basis too, but it is more practical to increase the bathroom visits to every 4 hours.
Fluid intake is important too and should be about 1.5 litres each day (unless a doctor advises you otherwise). It is important to maintain a healthy bowel and digestive system.
If you have any problems consult a doctor or nurse specializing in incontinence problems
Christine Kennard wrote about Alzheimer’s for HealthCentral. She has many years of experience in private and public sector nursing care homes for people with dementia. She has worked in a variety of hospital, public and private health settings and specialized in community nursing. Christine is qualified in group analytic psychotherapy, is registered in general and mental health nursing and has a Masters degree.