My parent was diagnosed with dementia about four years ago. The problem I need advice on I found about a year ago. When going to the bathroom, she uses her index and next finger and thumb to pull out her feces. She has always been constipated all her life and took a lot of laxatives many years ago. My younger sibling said she has done this with her hands all her life too, she saw her do it before. Well over a year ago I found out because she gave herself pinkeye and a very severe infection on the skin of her nose. She had to be hospitalized for a week, she also had a UTI because of the bad hygiene habits. I was undergoing chemo last year and am her caregiver, so this was very stressful for me. I tried to reason with her, explain it, etc. and she said she would never do it again. She would get up from talking with me and go do it after swearing she would never and does not do it anymore. I saw her with it all over her fingers and she said she was not doing anything. I asked how that happened. She said nothing happened. She will not admit she does it and will not stop doing it. I tried giving her a laxative once a week, she will go in after taking it and do it before the laxative can work. Some days she seems normal, then she will have a day when she is in another place. I told the doctor he said make sure she washes her hands. So I tell her to, she said she did, but that means rinsing in water to her. So I have to have her go back and use soap and a brush. She gets upset and very angry when she has to wash so much. This is very dangerous to her and to all who could come in contact with her. Five people have told me her hands smell badly. She said they are liars. I need advice on how to deal with this.
Expert Answer by Joyce Simard
This is a very difficult situation as you cannot expect your mother to change a life long habit when she has dementia. Give her fiber caps on a regular basis to see if that helps without having to use a laxative. I'm assuming that her diet is full of fiber that will naturally help her with elimination problems. You could see if she would get into the habit of wearing gloves whenever she goes into the bathroom. the only other way to control the hygiene is to monitor her bathroom visits so that you can make sure she washes her hands and of course keep her fingernails clean a trimmed. This might be something you can do that is a fun "beauty day" experience. Soak her hands in soapy water, clean and trim the nails, have her choose a nail polish color and compliment her choice. Then you can lotion her hands and arms. Play some soft music and make her feel as if she is in a "spa".
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My sister and I are taking care of our 96 yr. old Mom.
She is NEVER constipated and I will give you the BEST advice ever!
In the morning have your Mom drink a hot lemonade with honey. And in the evening have her drink the same. If she is still constipated, make a pot of Senna Tea (only one tea bag). Be sure the tea is not too strong, (THIS IS VERY IMPORTANT) it will give her diarrhea, and you do not need this nightmare! All she needs is one cup. You may refrigerate the rest of the tea for the next day. Add honey not sugar to sweeten if desired.
Laxatives are not the answer.
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I dealt w/the same issue. Still cannot get her to wash her hands after using the bathroom and what sickens ME is she goes directly from the bathroom to the refrigerator. She also has dealt w/constipation every since I can remember. This is what I have done: I add prune juice to her other juices; I also put fig bars for her to eat as a snack; she thinks she's eating a cookie; this keeps her regular; I actual do the nail night; which she loves, the only thing is I have to wait until I know she'll be open to it. I also purchase and make available: disposable hand wipes and wipes specifically for wiping down sinks, toliet, door knobs, etc. that kills germs. I put this on her food tray.
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There are already several good recommendations in response to the situation you are going through, so, I wanted to bring up 2 different thoughts here. Your mother has dementia. When you say, "I tried to reason with her, explain it, etc. and she said she would never do it again. She would get up from talking with me and go do it after swearing she would never and does not do it anymore.", it says to me that you are trusting her to understand reasoning and not to lie to you. With dementia, she will promise you many things, however, that does not mean she will remember those things when it is time to. Don't take it personally. She may have the best of intentions to do what you ask, but, is truly incapable of following through. With dementia, it doesn't matter how much time has passed since you talked to her about it, whether its 10 minutes or 10 days. Her memory is like that of a child. They forget almost instantly, if not instantly. So, in this instance, you may want to treat her like you would one of your own children when they are being potty trained. You wouldn't expect them to be able do everything they need to do in the toilet correctly. Don't expect her to, either. Yes, that means that you will have to go in with her. It may be difficult at first, on both of you, but, try to stay calm and patient. Explain why you are in there with her and that you are doing it for hers and your protection. Very important to just remain calm, even when she yells. You may want to make sure there is no lock on the bathroom door that she uses, also, just in case she goes in and you haven't noticed at first. Secondly, I found in taking care of my mother-in-law that she loved her doctor and would listen to him and follow his advice, when prompted to do so. So, when she raised a fuss about anything, from taking her medicines to staying in bed because she was having a weak day, all I had to say was that her doctor wanted her to do it and she almost always accepted that. I would make it a point to talk to her doctor, in front of her, about the concerns so that she did hear it coming from him directly, at first. How is your mother's relationship with her doctor? Does she trust and like him? I would bring this topic up again at her next appointment and have him tell her in detail why she should not be doing this and what the effects are and how unfair this is to both her and you. Try not to lay blame on her about lying to you and such, especially in front of other people. That is almost always going to anger anyone, especially someone with dementia. Let her know, while your with the doctor, in a concerned, loving voice that you are trying to help her and that you need her to help you with that. Okay...I think that covers what I wanted to say. You didn't say how long you have been taking care of your mother or what stage of dementia she is in. I'm not trying to preach to you, at all. I am just giving to give you advice on what I have learned about dementia because of my mother-in-law. I hope this helps you. Please let us know. I will keep you in my thoughts and prayers.
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My 89yr had constipation that was giving her back pain. She also can't wipe herself properly and frequently gets poop all over her hands and the toilet seat. Her hands smell like pee a lot of the time.
I solved the constipation with one stool softener pill (not the ones the include laxative)at her breakfast. When I get her to eat right, I stop the pill. Lots of fruit helps. The one suggestion here about fig cookies and prune juice is also good.
The dirty hands also concern me. I'm afraid she will also get me sick. She get poop all over her clothes too. Wit Alzheimer's the brain just doesn't work, so reasoning, training, gloves and sanitizers in the bathroom don't work. If it wasn't a habit before, it certainly won't be learned now. She will frequently get very mad and swears I've got memory problems if I even try to suggest she is leaving poop all over herself. Even when faced with the evidence of stinky dirty hands she thinks I'm the one with the problem.
The only thing I have found that works is to follow her to the bathroom and "suggest" she use soap. This is frequently met with anger (who are you to tell me to do something I've done my whole life).
If you go to a nursing home, you will see this is somewhat normal behavior and it gets worse (playing and smearing). I have yet to see anything that works. My father (in the nursing home) used to go around with poop under his nails until we visited and did a "nail day".
I don't let my mom prepare food but she is still touching everything in the house. All I do is try try try to get her to wash frequently with soap. I am getting good at constantly changing how I approach problems. What works one day won't the next.
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My mom is pretty far along with Alzheimers and I am her full time care provider. She had constipation for years and recalled having to have (digital) help from my dad even when she was in her 40s. Later, during a surgery for something else they found that her intestines were twisted and supposedly straightened that out. But, it only helped for a while.
I guess I was lucky to know this history, because when I found her getting so constipated that she would stop eating and had more memory problems than usual, I found a solution that worked for us. I donned the rubber gloves. I had been using wipes to help her clean up after BMs since it was very difficult to do a good job. I think her case worker started having them added to her order for pull ups and that made me think, hey, that is easier than paper for the kind of BM that the medicines make.
I have no problem doing this for my mother. She was very happy that I was not put off. At first it was only when she couldn't deal with it herself. Now, I assist her with every toilet trip.
Her Alzheimers/dementia has advanced so that she doesn't even feed herself. So it is a natural transition. I mentioned it to the doctor and he was alright with this. He also added Miralax, we tried the prune juice (she won't drink it even in something), she won't eat the fiber wafers and chokes on most food with any texture. So I am constantly balancing her diet and only occassionally add a laxative to her large repetoir of pills.
One thing that did come up was that the ducosate she takes twice daily could be adding to the problem since she is no longer able to sit up for longer than an hour.. several times a day. She is not active physically and she doesn't drink enough. I can't get her to drink more than a few sips with her meds. I hope this helped in some way.
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constipation vs behavior issue. They can't remember what they just did and become frustrated and angry with you. Have a talk with your doctor.He or she can help. Some laxatives can interfer with medications. Good luck!!
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