It seems rather humorous to go from a blog on dehydration to one about incontinence. I am quite sure that Mom never dreamed while changing my diaper when I was a toddler that someday I would be changing hers. Normal bodily function or not, it was a topic that she shied away from mentioning.
Mom was in the later stages of Alzheimer’s when she started complaining of a pain in her belly. The complaining was most likely a habit after a bout with constipation, but never-the-less one of her doctors ordered a colonoscopy to investigate the pain. Now, picture an 80-yr-old woman with advanced Alzheimer’s prepping for a colonoscopy! At that point in time, she had refused to have around-the-clock care in her home and we relied on the help of her wonderful home healthcare aide to get us through the procedure.
We tried to explain to Mom what was involved in prepping for the test, but she absolutely did not want anyone in the house with her. I finally resorted to calling the doctor’s nurse and explained that my mother was an Alzheimer’s patient and that she did not understand the significance of the test and the preparation for it. The nurse immediately understood and called Mom to give her further instructions from the doctor that she must have someone with her for the preparation. Mom still did not understand and continued to insist that she did not want anyone in the bathroom with her, and told the aide not to come the day before the “surgery” as she called it.
I quietly told the aide to just show up that afternoon around 4:00 on the pretense of picking up something she had forgotten and to stay as long as Mom would physically let her. The aide showed up and sat down to tea with Mom, but it wasn’t long before the first dose took effect and the purge began. Mom couldn’t keep up with it on her own, and as the evening wore on, she changed her mind and suddenly decided that it was a good idea to have the aide there after all.
There wasn’t much to be embarrassed about regarding incontinence after that. Either Mom finally acquiesced to Elena’s assistance or she gave in to the futility of trying to deal with remembering when and how to toilet herself. From the day before the colonoscopy going forward, she gladly wore adult diapers and allowed herself to be changed without complaining. She declared the “surgery” a success, had her name taken off the prayer list, and never complained about belly pain again.
Perhaps because my sister had children and had acquired a very matter-of-fact approach to toileting, she was able to talk to Mom in an everyday conversational tone about which brand and size of adult diapers would be best and which body wipes did the best job. Approaching incontinence in such an open and frank manner reduced the feeling of embarrassment and reassured Mom that this, too, could be dealt with in an adult manner. Sister refused to make a big deal over it, and Mom eventually adopted that same attitude until she reached a point where it no longer mattered to her.
* * *
Aside from memory loss, there are many factors that could be causing incontinence, including medications, constipation, and stress. A visit to the doctor can help determine the cause and to find ways to manage incontinence. How you respond can help your loved one maintain his or her dignity by not allowing it to become a focal point in living as full a life as possible.
* * *
“A Bandaid for the Caregiver” is dedicated to all those families who journey with memory loss in their lives and the sharing of hope and joy and new possibilities. In each difficult moment there lies an opportunity for love.
Journey with courage,
Elaine
THE BANDAID BOX…
STAYING ACTIVE…
Journey with courage,
Elaine
THE BANDAID BOX…
You are in charge of your own thoughts and feelings. When presented with challenges, make a conscious choice to respond in a loving, patient and kind way. Dwell on the positive in every situation, no matter how small it may seem. Patience, love, and a positive attitude will continue to grow and crowd out doubt and fear.
“Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things.” Philippians 4:8
“Your own mind is a sacred enclosure into which nothing harmful can enter except by your permission.” Arnold Bennett, English writer (1867-1931)
STAYING ACTIVE…
A regular routine of going to the bathroom helps not only in managing incontinence, but keeps Mom on the move. When it is difficult to motivate her to get up and get some exercise, using the bathroom can be a big motivator. After all the effort of getting out of a chair, walking into the bathroom, partially undressing and then reversing the whole process, she might as well go for a little longer walk, help with loading the dishwasher, put away some clothes, retrieve the paper from the driveway or go to the mailbox.
Look for ways to engage her in pleasurable activities right after a trip to the toilet. If she knows that every bathroom visit is followed by a scoop of sherbet or a cookie and a drink, getting out of the chair and moving about has a happy ending.
TREAT YOURSELF…
If you treat your parent to a snack after each challenge is overcome or task accomplished, why not treat yourself also? Reward yourself with something that entices you to be extra patient and loving. For me, that would be leafing through a catalogue or munching on a candy bar. If it isn’t convenient to stop for a treat, I give myself a little pat on the back and say a prayer of thanks that we made it through another pit stop without any tears or angry words!
Gentle Reminder:
Your parent’s new “normal” is also your new “normal.” It isn’t easy, and rejoicing in small accomplishments is a big part of successful living.
IN THE NEWS…
CAREGIVER TIPS…
Help Mom maintain her toileting skills as long as possible by keeping the bathroom door open so that the toilet can be seen. Remove any obstacles in the pathway to the bathroom and make the bathroom standout with a colorful sign on the wall next to the door and a colored non-slip rug on the floor in front of the toilet. Install hand railings next to the toilet and a high-rise seat to make it easier on arthritic knees. Remove anything that can be mistaken for the toilet such as wastebaskets, dirty laundry baskets or potted plants.
Choose clothing that is easy to remove, run the water in the sink, and check the bowl to see if Mom has urinated or moved her bowels. Allow as much time in the bathroom as needed to accomplish the task. Keep body wipes handy for easy cleanup.
Rather than using accusatory language pointing out any mishaps - “You wet yourself”- try saying instead, “Something spilled on your lap.”
Set up a regular schedule for toileting. Making this a routine helps set a rhythm for the day and Mom knows what to expect. Take her to the toilet upon rising in the morning and then every two hours after that. Visit the bathroom after each meal and again before bedtime.
For more caregiver tips visit the Alzheimer’s Association website. http://www.alz.org/care/alzheimers-dementia-incontinence.asp#respond
ABOUT ALZHEIMER’S…
Alzheimer’s is often blamed for incontinence, but there are actually many possible causes, including a urinary tract infection, constipation, prostate problems, diabetes, stroke, or Parkinson’s disease. Sometimes, the difficulty may lie in a physical disability which prevents Dad from getting to the bathroom in time. Sleeping pills, muscle relaxants, and prescription diuretics or caffeinated drinks may also be the culprit.
To help identify when accidents may occur, watch for these nonverbal signs that Dad needs to use the toilet: tugging on clothing, restlessness, pacing, sudden silence, hiding behind furniture or a change in facial expression.
When the ability to toilet himself is to the point that Dad can’t remember where the bathroom is and what to do once he reaches the bathroom, it is time to consider using adult diapers and protective mats on the bed or to move him into a care facility.
No comments:
Post a Comment