Any tips or strategies for handling incontinence and bathroom hygiene issues that have now begun?

This sounds bad but one thing these elders seem to get, dementia or not, is that they don’t want to go into a home. So you tell her her choice is to wear the depends. Or it’s a home. If she can’t get that as it is and you now have human waste contamination through the home it is time to put her in one.

Your tone of voice & body language is even more important than the words you use with mom, as she will respond to that language more so than words. Don't argue that 'she did that', just that it's time to get changed. I wouldn't be threatening mom with a 'home' b/c she's not likely to respond well to negative talk; positive talk gets a much better response from elders with dementia; plus, she's not refusing to wear briefs; just arguing that she didn't 'create the mess' to begin with. My mother was VERY argumentative about things; refused to take ownership of anything, especially in the advanced stages of dementia. It is what it is; brain damage causes all sorts of unexpected headaches for EVERYONE involved, that's for sure.

"You are not a dirty person at all mom, something must have spilled on you & now you need to be changed into something cleaner, that's all." Smile & exaggerate your enthusiasm; if it feels like you're 'overdoing' it, you're doing things PERFECTLY for an elder suffering with dementia!


I suggest you read this 33 page booklet (which is a free download) which has THE best information ever about managing dementia and what to expect with an elder who's been diagnosed with it.

Understanding the Dementia Experience, by Jennifer Ghent-Fuller 
https://www.smashwords.com/books/view/210580


The “Dont's”

· Do not reason and argue
· Do not demand that they reason or problem-solve
· Do not demand that they remember
· Do not demand that they get their facts straight
· Do not correct their ideas or scold them
· Do not reorient them
· Do not think that they are being uncooperative on purpose
· Do not think that they really do remember, but are pretending not to
· Do not use a “bossy” dictatorial attitude in care
· Do not act with impatience

The "Do's"

· Enter into their frame of reality, or their 'world'
· Be aware of their mood or state of mind
· Use few words and simple phrases
· OR use no words, just friendly gestures and simple motions
· Do everything slowly
· Approach from the front
· Wait for a slow response
· Constantly reassure them that everything is 'OK'
· Keep people with dementia comfortable 'in the moment' - every moment
· Maximize use of remaining abilities
· Limit TV or radio programs which they may feel are frighteningly real
· Maintain privacy
· Provide a safe physical environment

Language Needs

· Use short words
· Use clear and simple sentences
· Speak slowly and calmly
· Questions should ask for a “yes” or “no” answer
· Talk about one thing at a time
· Talk about concrete things; not abstract ideas
· Use common phrases
· Always say what you are doing
· If they repeat their question, repeat your answer as you did the first time · Give them a longer time to process information
· Wait patiently for a response
· Be accepting of inappropriate answers and nonsense words
· Speak softly, soothingly and gently

Care Needs

· Recognize that receiving personal care feels intrusive
· Reassure with your tone and manner
· Do one thing at a time
· Talk through the care “play-by- play”
· Be aware of your body language and use it to communicate relaxation and reassurance
· Be sincere
· Use a soft, soothing touch
· Be aware of the individual’s unique triggers
· Be aware that a person with dementia may not accurately judge whether a situation is threatening to them
· They may respond to fear, pain or anxiety by defending themselves with what we call “aggression”
· If they become distressed, stop immediately and allow them time to calm down – don’t try to restart the activity right away
You need to change your behaviour to adapt to the dementia because the person with the disease cannot.

Another good book is Living in the Labyrinth: A Personal Journey Through the Maze of Alzheimer's, by Diana Friel McGowin. Learn all you can about AD/dementia b/c knowledge is power.

Best of luck with all you have on your plate!

That is tough. Similar situation with my mom. They just don't get bathroom hygiene either. I have a real hard time with it and it if/when it progresses further, it may well be the straw that breaks the camels back.

I understand what you are going through. First off, it really doesn't do any good to point out the poop smear on the toilet seat. A Clorox Wipe will take care of that. Keep a box of gloves under the sink for picking up used toilet paper that didn't make it into the toilet bowl. I just can't see a 'win' by pointing out that you have to clean up after her AGAIN! She's not going to own it, and you'll end up cleaning up the mess in the long run. Why have harsh words. Second, you don't think she is 'dirty', it's just that you noticed that a cleaner pair of pants might be a good idea. You didn't realize those needed washing before she got dressed. Make it YOUR fault, not hers. You'll get a lot further if you try to remember two things: Practice Patience and It Is Better to Be Kind than to be Right.

SOS - Assisted living. Save your relationship and your memories by getting her placed in a safe environment with professionals.

There is the shame factor with incontinence, and it's difficult to handle it without invoking the shame. Is she incapable of handling the cleanup herself? Have gentle wipes handy in the bathroom to clean up, but they shouldn't be put in the toilet. Get connected with a local social worker who can advise you on your mother's options. Is she eligible for home care, and if so, how many hours and times a week? Do you think she'd accept an outsider coming in to help her clean up and change clothes if needed? Try to get someone who is experienced, to help her get acclimated to being helped in this way. Good luck!

Stock up on gloves, paper towels, Lysol wipes and just go about cleaning the mess matter-of-factly. It was a huge shock for me when mom became incontinent and my husband had to clean up her BM messes since I just froze & couldn't handle it. I'm also a preschool aide, so now poop has become a daily affair for me.

It took a while for me to stop pointing to mom "look what you did!" Like you said, my mom also says "I didn't do that" etc. I was an idiot and thought showing mom her mess might make her stop doing it..duhhhh...

I'm hiring a cleaning lady to do a deep clean of the house monthly.

The sad part in all this is, I just do what is needed to keep mom safe & clean. I don't feel talking to her at all since I've to explain the context of everything which is draining me mentally. After 3 years of caring and no end in sight, I've lost patience and do caregiving like a robot.

Good luck to you.

I remember when my mother-in-law got sick and had diarrhea. She felt horrible, said she worthless, a burden, I had become a servant, she should be in a "home" etc... Its not easy for them.

I helped her into the shower, we rinsed her clothes, put them in the washer, cleaned the floor and changed the bedding while she dressed - the whole time I just kept telling her "it is okay - - These things happen to everyone" that I I didn't feel like a servant". Just kept reassuring her, that I love her.

Its been much better now. When she needs help she is not afraid to ask and knows she isn't judged.

Yup...I have been there and found great solutions!...Let me tell you.
At first, I was like you....yuck...she did it again and poo is all over the floor and smeared on toilet seat.

Then I went looking for solutions....some I found here and some at the hospital.
For smeared poo, just wipe it off and keep disposal gloves in the house. I buy them bulk through Amazon (very cheap). Then there is a produce called ToidyMats....you can google it and I bought those to put on the floor in front of toilet. It catches poo and urine spray....a life saver because now, you just change toidymat and the floor stay clean.

For smell, I buy those spray you use on garbage cans...works great. They sell them at Home Depot. Then for floors, I mop with a little bleach and water and squirt of dish washing detergent....Again, it works great!...bacteria and all are gone. You are right to be concerned about being "dirty" because poo and pee carries bacteria in them. At the hospital, they mop with a powerful baterial killing product. You can buy those at Staples. I found the exact same product selling at Staples.

Now for the best part....you can see from the poo where Mom is in good shape or had diarrehea....then I add in more fibre (apple crisp buicuits sold at Wal Mart - Metamucil Apple Crisp Fiber Thins. Mom eats them with abit of milk.

Yep....it is great now. Mom is clean (wears depends) and floors are good and I do not worry about abit of poo here and there anymore....In the beginnning it was bad but with all the nice products out there, it is fine and in some respect, you can check on Mom's health by looking at the poo....so I am not complaining.

Retrored: Perhaps you could say something akin to "Mom, I wear a feminine pad also for those sneezing episodes that precipitate a leak." Then she may not feel badly. "It's a girl thing" could be said.

This may be a weird segue but yesterday I went to mil/fils house. And during conversation mil mentioned that she was sure so would diaper them and clean them when they need.

There is not one thing that freaks him out more than dealing with incontinence. I told her I doubted he would do it for me. He would try of course but could not psychologically handle it. Most ppl cannot.

My mom is at the point where depends would be a better solution than cotton panties with thick pads placed in them before they are put out for her to wear. One family member who is the other regular caregiver feels strongly that we should not upset mom or make her feel old...not sure if I will be able to manage to get mom to make the switch on my own.
I had a very clear and direct conversation with her a few months ago to make it abundantly clear that body wastes and TP are the only items that go in the toilet. No Kleenex, no paper towels, not ever. That did work, and she has not 'forgotten.' At 90, her dementia is more vascular in nature.
I am a nurse, but I will not do toilet hygiene for my mother on a regular basis. In an emergency, of course. When it becomes a daily need, I will put my foot down. 
That is my personal choice.

have you mentioned this to her doctor and tried to get her physical therapy? Sometimes it helps.

Keep telling her they are for her comfort and ease of use. You might also consider adding a bidet attachment to the toilet so she gets "cleaned" every time she uses the commode. Lether know that the bidet is for everybody to use .

A few months back before christmas my mom (94) with Late stage Alzheimers & Vas Dementia started pooping a lot, more poop than I had only seen from a german shepard, no joke and this went on for 3 days and not sure why. Took her to the dr and I think she gave some meds for infection. Mom had no choice but to get some disposable panties (depends) because of what happened. She then became constipated a week later and didn't poop for 3 weeks and her stomach started hurting so dr told me to start giving miralax and fiber powder daily till she could go again, well that started a week later, very soft stools and finally she started going regular again. She's been wearing depends ever since, thank goodness. Some times I catch her with reg panties and I tell her no more wearing those. I clean up after everything she does and she can't seem to wipe her left side at all so she ends up with poop on her hands, on the toilet, floor etc. Daily cleaning now :(

If your mother is at the point where she saying "I didn't do that" and "Are you saying I'm dirty?" then she has reached a level with dementia where you will have to remove all of her regular underwear and replace it with disposable briefs (aka diapers with tabs).
I've been an in-home caregiver for a very long time. If I had a nickel for every time I've heard the "I didn't do that" and the "Are you saying I'm dirty?" I'd have a hell of a lot of nickels.
I'll speak plainly here and please don't get me wrong.
When someone is sitting in their own sh*t there is no pride or dignity to protect. The answer is "Yes, you did do that" and "Yes, I am saying you're dirty because you are". These responses are then followed with, "Let's go and get cleaned up. It will only take a minute".
Always try to be inclusive when it comes to diaper changing and showering. I'm always careful to avoid saying things like, 'you have to get changed' or 'I have to wash you up now'.
With me I always use 'let's and we'.
Of course I've had many stubborn seniors who would literally be sitting in their own sh*t who would adamantly refuse to be changed and washed up. I've had to literally stick clients hands in their diapers to let them see for themselves that they have to get changed and washed up.
If you actually stepped in it, then your mother should probably be in actual diapers and not disposable underwear.

Helen4sure,

You sound like a lovely and kind person. With all respect, you don't know what you're talking about. It sounds nice to think that the kindness and sweetness will get a stubborn, incontinent elder to willingly start wearing diapers and stop fighting tooth and nail about it. Or being in total denial about it.
It sounds very nice, but in the real world it doesn't work like that.
I've been an in-home caregiver for 25 years and I can say from much experience that sometimes you have to play the nursing home threat card. Like I said in my response to PeggySue about my last long term care client. She'd be on the floor every day covered in piss and sh*t with a tipped over portable commode beside her. All the coaxing, kindness, and sweetness did not lessen any of the stubbornness. The threat of a nursing home is what enabled her caregiver (me) to keep her clean and comfortable and at home.

I have a horrible gag reflex and use a dab of Vicks Vapor Rub under my nostrils while cleaning.

Thank you all for your replies :) and suggestions

Mom finally got over whatever issues with pooping she had and now goes like normal again and once a week I still give her Mirilax and fiber powder daily.

She also wears depends now with no issues because she knows she needs them and they work better then maxi pads that she was using for urine incontinence :) so if she feels urine coming at least it goes in the depends and not all over her.

I keep antibacterial wipes and gloves near by and use them daily