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How can I stop my mother with dementia from handling her feces and to wash her hands?

22 answers | Last updated: Sep 21, 2014
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Caring.com User - Joyce Simard
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A social worker and geriatric consultant who specializes in dementia care, Joyce Simard is based in Land O' Lakes, Florida, and in Prague. She...
38% helpful
answered...

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 See also:
Dementia and Driving: Is It OK?
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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63% helpful
carolb answered...

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.

 

33% helpful
SDJ answered...

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.

 

71% helpful
LindaSD answered...

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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An anonymous caregiver answered...

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!!

 

75% helpful
Journey002 answered...

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.

 

75% helpful
Charcares answered...

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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50% helpful
An anonymous caregiver answered...

My mom also has a problem with hygiene after having a bowel movement. She sometimes doesn't make it to the bathroom and goes in her underwear, then takes off the underwear and washes them in the sink, which I've told her many times not to do. So now she lies and says she washes them out in the toilet, but I can see the water mixed with feces all over my sink. It's disgusting and she doesn't wash her hands with soap, just rinses them with water. I've told her many times to put the underwear in the washer and I'd rinse it and wash it in there, but she gets mad at me and says I'm bossy.

 

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Kath2 answered...

I am so grateful for all your suggestions. I did an Internet search on this issue and at first could not find anything and thought I was alone in all of this! We are all very upset in our house by my 94-year-old mother's behavior. We find her with feces piled in her hand or on the sink and smeared all over her hands. She lies about it and makes the promises too. We have even noticed some days her breath smells just like feces. It had never occurred to me that she could be eating it but now I believe it is a real possibility. Last year she had an extended bout of diarrhea, so I threw out all the laxatives I found in her bathroom and tried different suggestions from her doctor--cutting out gluten from her diet and giving her lactose free milk. This seemed to resolve the diarrhea problem, but now we have the "other" problem. I'm not sure now which is worse. I've been giving her Citracel (another suggestion from her doctor), but I think the fact that she just won't drink much water increases her constipation. It sounds like there is a similarity here. Maybe somehow we need to increase their intake of liquids.

 

33% helpful
nancybh answered...

Well my mom has Alzheimer's and Dementia she is 76. She was dignoised in 2008 now she pee's and poop's on herself. she lives with me I'm just one of her thirteen children. I go with her to the restroom and I wipe her with warm baby wipes ( I wear gloves) and after shes finished I wash my hands and make her wash hers I tell her if i don't wear gloves and she doesn't wash her hands she will get an infection and end up in the hospital and she tells me im not going there, so she does it! She may pee and poop on herself 5 r 6 times a day! Mom will use towels r wash clothes to clean the poop off her, "Nasty" I don't get on to her I just throw them away, now I have removed them from bathroom. Don't get me wrong she slips to bathroom sometimes and swears she didn't leave that mess n bathroom! I just santitize the whole bathroom and go on!!!Hope this helpful!!!!

 

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An anonymous caregiver answered...

My mother, now deceased, had dementia or alzheimers disease. She, too, had a problem with bowel movements and cleanliness. I ensured that all of the dietary and fiber needs were addressed and learned in the process that Mirolax is a wonderful resolution. I took my mother to a gynocologist and from that physicial examination learned that she had a herniated rectum. Thus, the need and life long habit of using her fingers to press in on the side of the rectum to enable a bowel movement. The gynolcologist recommended a pessalary (spelling??) which the physician inserts into the vagina or uterus and it effectively "held" everything "up" and made her bowel movements much easier for her to manage. It necessitated a monthly visit at which time the physician removed the pessalary, cleaned it and coated it with Estrace (a hormone cream) and reinserted to help with the next months movements. She also had my mother vaginally insert Estrace cream three times a week. This hormone "plumps up" the tissues which also helps to hold the organs in place. This was a wonderful medical solution for my mother's problem. The hand washing and nail cleaning processes of course were continued. I hope that this simple piece of information helps someone struggling out there!!!

 

67% helpful
missaudra68 answered...

I am a full time care giver of dementia patients. I have worker with all stages of this disease and can tell you that it isn't something that they are doing purposely. I mean, they would never in their youthful mind play with feces. I do know of many people that feel that they need to disimpact themselves with their fingers that have their mind. this becomes a long standing life reality for people and they seem to just do it automatically. Getting upset with them isn't going to make it go away. If they have dementia then you can ask them to do something, or in the case not to do something and in five minutes they won't remember the conversation any way. It's very important for people with toileting issues to NEVER be left alone in the bathroom. Using wipes on their hands is a good idea, if they will allow it, but keeping the mess from happening in the first place should be the main goal. Realize that this is something that they can't help and don't understand what they are doing is wrong. if it's something that you can't handle, sad and sorry to say, you probably shouldn't be the one to care for this person anymore. You have to have alot of patience and understanding to do this work... Knowledge is the key to good caregiving.

 

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SDJ answered...

Hello everyone, I am still a bit frustrated with the BATHROOM issues, but it is what it is. I have tried ALL the things suggested, however, eventhough my mom is coming back and forth into the last stages of Alzhemiers, she is EXTREMELY STUBBORN. The Spa day is not something she EVER did in her pass so it is not fun and causes issues, so it's something I have to push her to let me do after I've just had enough; the constipation was getting worse and worse, (Metamucil, Prune Juice, and a liquid medication prescribed by her physician and stool softners and she was still getting constipated until I finally figured out what was going on - SHE HOLDS IT. So now every weekend, I have to stick a suppository up her rectum to force her to push it out. She refuses to sit on the toliet long enough for her bowels to move; she gets up off the toliet and literally tries to walk with the pull up and pants down to keep from staying in the bathroom - I even let her keep the door open because she is in such as state of paranoia. This disease is torture from the "pit of HELL". I pray everyone who has to deal with this in ANY respect (caregiver and patient, etc.)

 

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50% helpful
An anonymous caregiver answered...

Just a few comments regarding the treads here... 1. Docusate (stool softener) is often ineffective and there is no evidence to support it's use. 2. If increasing fiber, it is essential that fluid intake is increased as well. If your family member is dehydrated, the fiber will only clump and cause more constipation. SO, if increasing fiber, increase fluids as well. 3. If your family member is on morphine , codeine or hydromorphone (narcotics), it is important for them to be on a bowel medication as well. 4. Someone made a comment about diarrhea. Note that diarrhea can also be a symptom of being constipated. If there is a large hard stool further up the bowel, the soft stool or diarrhea bypasses the clump and is having diarrhea. Other symptoms include nausea and abdominal pain. 5. If diet is consistent and you have been able to create consistent normal stools (through diet, fluids & medications) then, consider a toileting schedule. See if there are patterns. Is there a time of day that your parent has their BM? Try to accompany them to the toilet before the need to self disimpact occurs. Note: the urge to defecate usually happens within 30 minutes after a meal.

Bottom line is that constipation is a huge challenge. What works for one person, doesn't work for the next. You may need to try several things before you find what works. Good Luck

 

Able Bidet answered...

Toilet seat bidets have a warm water wash with an enema nozzle function. This can gently and effectively remove impacted feces without using hands. The jet of warm water helps to clean and relieve constipation naturally.

 

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An anonymous caregiver answered...

Well you are describing two different things here. First you are describing a situation that results in a behavior that you find repulsive. 2nd you are describing a failure to clean up after that behavior. Long ago I would have agreed on all counts. That was before I met a person who had nerve damage around the rectum and was told by the physician that it caused failure to properly defecate and resulted in poisoning the body. I only discovered this situation when that person became disabled and required a care giver's assistance. This person was provided with gloves and lubricant to "stimulate the rectal walls" and initiate defecation. There are many reasons that people do what they do. When a behavior is strange to you it may not make sense. Since she may have a requirement for this behavior it could be helpful if you could find a way to embrace the personal need and try to find a way to remediate any resulting sanitary issues that are likely exacerbated by age decreasing the senses and mobility required to address the clean up issues.
Grow up. Get older and wiser. Try not to treat people in a manner that causes them to want to hide from your judgement. Perhaps someday your opinions will change based on increased life experience. Meanwhile, try to think in terms of what is best for the mental and physical health of the person you are caring for and not what makes you feel better.

 

100% helpful
KatB answered...

Do NOT use colored polish on the nails. How will you be able to tell when they're dirty? My Experience: I asked the caregiver (I'll call her "Sue") for my mother-in-law to check & clean my MIL's nails daily. ( Sue comes to the house) When I visited a few days later, I found my MIL with hot pink nails. When I asked Sue about it, she said my MIL liked the color. Okay, in 25 of knowing her, my MIL never had her nails painted. She loved them trimmed, neat and natural. I asked Sue if she was still cleaning them and she said yes. A few days later, after Sue left for the day, I removed the polish and took pictures of my MIL's filthy nails. I confronted Sue the next day, showed her the pics and told her that the nails must remain clean and trimmed, no polish. For holidays we paint a bit of clear glitter polish.

 

Anita_R answered...

Another natural way to help with constipation and not turn into diareah. I give my father who also has dementia. Acidophilus or probiotics its natural and you keep it in fridge bc it's a live culture. You can open the capsule and mix it in drinks or apple sauce and has no flavor. Hope this helps.

 

100% helpful
katie999 answered...

I feel the pain of everyone here. My 96 year old mom is growing weaker by the day, and I have been her full-time caregiver for 5+ years now. I know it can be frustrating; I have always been close to mom, and it breaks my heart to see her as she is. However, I am grateful that I can care for her at home, and I try to make the best of each day with her. Because we have always been close, she is very cooperative and tells me when she has had an accident. (She is in TENAs, which tend to prevent UTIs better than other brands.) We use Aloe Vesta to remove any stool from her backside or lady parts, because she likes the clean scent and it doesn't require rinsing. This is a foam, and cleans without causing bacteria to flush back up into the urethra as some other methods do. CVS has their own brand - a little cheaper. I also keep flushable wipes by each toilet. Re: constipation, we use a probiotic each morning called Bio-Salud, GOOD STUFF, little bottles you get in the dairy section at WM, original is orange flavored and she loves it! I make sure she gets any food that contributes to regularity - spinach, applesauce, etc. Since she has lived with me, regularity has gotten BETTER, so I know we are doing the right things. I AM VERY involved in all of Mom's ADL'S, and really try to do everything with a smile and a joke and a hug, and remind her every moment that she is loved. That's the key - makes her more cooperative and it makes ME feel better too!
I will pray for all of us.

Exodus 20:12

 

nors answered...

i have worked in a nursing home for 30 years and have seen it all, i feel for you all with this problem of feaces getting everywhere, all these people that are supposed to be the experts who never actually have to do this themselves need to get on the floor or work woth someone with dimentia and see how difficult it is to stop them from putting their hands in their own feaces. a person with dimetia doesnt know that their doing it and will deny it if questioned, the only answer is to deal with it, you could try buying online cotton protection gloves, this way you can just change them or throw them away, i know its not perfect but will reduce a lot of problems. good luck, i do feel for you all.

 

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An anonymous caregiver answered...

Dear God, pulling out faeces with fingers ! How disgusting ! I would rather be dead than in a state like this.

 

DSM answered...

This thread is very interesting and helpful, mostly to know that we are not alone as our loved ones slip away mentally. My mother will be 97 in September and resides in a Skilled Nursing Unit of a "lifecare community". She is a retired RN and also played the piano. Her finger nails were always clean and short. She has for the past 3-4 years suffered from the same NEED to assist her bowel movements. She has a permanent in-dwelling catheter which compounds the obvious body shifting and diet changes, creating the difficulty of normal bowel movements. She, too, will not drink enough. When she was in the Assisted Living wing, I would buy a case of water bottles, and could determine how much she consumed that way. Fortunately she does not "lie" and has remained mostly sweet and easy to work with. A hospitalization and over prescription of pain medicine (Fentanyl- a horrible drug for the elderly - combined with hospital psychosis combined with dementia brought her problem to light.) I knew that "it" happened occasionally, but this time in a temporary rehab room she was going to dinner with a dear friend and I came to help her choose her clothes, as it takes several weeks to get Mom back after a visit to the hospital. Her hands were full of it. After I confronted her and took her to the bathroom and looked at her and told her she knew better as a Nurse and she said some what defensively and very sadly that she never would have done that, I realized how wrong I was. As has been said here, we can't correct we just need to love. Specifically, though, 1. We found MIralax made everything too soft. Full of sugar I believe. 2. Changing or eliminating stool softeners, fiber, can lead to impaction, which we have had twice. Very painful and dangerous.3. We experienced the exact same thing with nail color. I will say that the Nurse called me and asked if I would agree to a red polish as Mom wanted it - it was Christmas time and all of the other ladies were being color polished. I knew we had a routine of cleaning and checking nails for all residents - which, frankly, began after I complained to a Nurse Supervisor 2 years ago. Unfortunately, and very important, they left it on and also allowed her nails to grow. I was unable to visit for several weeks and discovered her nails were at least 1/2" long! I took the polish off,and discovered a still existing nail fungus covering her left index fingernail. I now am documenting with photos. I typed in a search this morning, as I am approaching the Administrators today. They were testing their staff last week on proper hand sanitation! This is so frustrating, I know. One last thing. Mom has been pretty good about me giving her a manicure, I use a small plastic bedpan we received on a hospital visit. The Nurses always notice when you have a pink plastic albeit small bedpan on the table. However, she know refuses to go the hair salon. So I arrive on Tuesday morning to set her hair. Sometime she will tell me that she just brushed it and thinks it looks great - know what I do? I agree. Even if it looks like Mr. Einstein, which it does some times. I have had GREAT success telling her I am going to school and can I practice on her. You might try that with the nails. Everyone else is right - just follow to the bathroom and remind to wash - I have replaced Mom's fingernail brush numerous times. My next step today is to try and find out why, when this is really the only issue and assistance that Mom needs, she is still mobile with a walker, the CNA's and Nurses cannot know that she is in the bathroom. By the way, she takes a stool softener daily, fiber caps, we order the healthiest meals we can and a suppository every other day, which she "has the right to refuse". But she doesn't know what she is refusing and how that will make her feel!

 

 
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