Bowel Incontinence Care

How to Care for Someone With Bowel Incontinence

Ashley Lamar (not her real name) recalls how she and her sister first realized the scope of their mother's incontinence when they went to her apartment in Santa Monica. "There were big white bleach spots all over the pink carpet, and we asked the caregiver, 'What are these about?'" says Lamar. The caregiver told her that her mother was having "accidents."

"The thing I didn't realize was that my mom, who has dementia, had no sense of it. Some people have shame -- my mom didn't have any. She was walking around the house getting feces all over the place. She wasn't wearing underwear and refused to wear diapers."

Lamar had to make a special trip from her home in San Francisco to Southern California to get her mother to wear diapers, because her mother wouldn't listen to the caregiver. "It took three days. I just told her, 'This isn't your decision. It's not optional.'" Finally her mother got used to the idea and stopped protesting.

What causes fecal incontinence?

Fecal incontinence, which affects more than 5 million Americans and is more common in older adults, is often caused by weakness in the anal sphincter muscle, which normally contracts to keep stool from leaking out. Another cause of fecal incontinence is damage to the nerves that signal the need to have a bowel movement. Childbirth, straining to go on the toilet (which can happen with constipation), and diabetes can all cause injury to these nerves. There can be a disconnect between the brain and bowel caused by Alzheimer's, stroke, Parkinson's and other diseases that strike older adults. Even some medications cause fecal incontinence.

If the person you're caring for hasn't seen his doctor about it, schedule an appointment. Bowel incontinence could also be a sign of a more serious medical problem, such as fecal impaction, a condition in which hardened stool is lodged in the bowel, causing an obstruction and leakage of loose stool around it.

Plan a toilet schedule to minimize incontinence

You may not have the same sort of struggles that Lamar experienced with her mother, but if you're new to providing this kind of care for your family member, one of the first things you can do is help him develop a regular schedule for having a bowel movement. To do this, keep track of when he usually has a bowel movement and schedule a toilet visit before he would ordinarily have the urge to go.


About an hour after a meal is a good time to remind him to go to the toilet, says Carol Jones, a family caregiver consultant with the Mountain Caregiver Resource Center in Mount Shasta, California. "If he's having a breakfast of cereal, coffee, juice, and water with pills, within an hour you're going to have to take him to the bathroom," says Jones. She also suggests that you give him plenty of privacy, especially if he uses a wheelchair or is unable to move around on his own.


Don't rush him, she adds. "Give him as much control as possible, because this is another way he's losing his independence, another function that he has to hand over to someone else."

Watch what the incontinent person eats and drinks

Barring any medical restrictions, if he is constipated or has loose bowels -- both of which can lead to incontinence -- making some changes in his diet could help cut down on accidents. If he's constipated, try offering a diet rich in fiber such as whole grains, fresh fruits, and vegetables (which is a healthy diet for most people without constipation, too). Make sure he washes his food down with plenty of fluids.

Unfortunately, some of his favorite beverages and foods may be adding to the problem. Coffee, tea, and one of nature's best inventions, chocolate, may be pleasurable, but they tend to relax the internal anal sphincter muscles.

Other foods that can cause diar rhea include cured or smoked meat; spicy foods; alcoholic beverages; dairy products such as milk, cheese, and ice cream; fatty and greasy foods; and sweeteners such as sorbitol and manitol, found in diet drinks, sugarless gum, candy, and fruit juices.

To bulk up stool, try encouraging him to eat bananas, rice, tapioca, applesauce, yogurt, and oatmeal.

Keep him clean and comfortable

There's an abundance of products for incontinence, and some distributors even make house calls. To figure out what products would best serve his needs, see our checklist . Whatever you and your family member choose, make sure that he cleans up after a bowel movement. If he needs your assistance, wear protective gloves (if you're allergic to latex, drugstores often have latex-free choices)

If your family member is ill and bed-bound, family caregiver consultant Jones suggests ordering a pressure-reducing mattress, which will help prevent pressure sores. Anyone who is bed-bound needs to be repositioned every couple of hours to avoid bedsores or pressure sores.

If he uses a wheelchair, he should also be repositioned frequently and have cushions to prevent the development of pressure sores on his bottom. With age, skin becomes more fragile and can break down more easily. And feces can cause skin to break down if someone isn't cleaned properly after each bowel movement. T o protect his skin, try using cleansers that don't contain soap (soap can strip the oil from an older person's skin and make it more prone to breaking down). If you're changing him in bed, put down a disposable mattress pad to protect the bed. And if the budget permits, use soft cloths and no-rinse cleanser followed by a moisture barrier. For recommended supplies, see our checklist .


about 1 year ago, said...

This was an extremely helpful article. Within the last three weeks I have noticed that my mother has been having soiled undergarments and that she is not placing soiled toilet paper in the toilet anymore. I was extremely concerned since it seemed like such a sudden change in behavior.. I was uncertain about what to do and she is scheduled to see a doctor today. It helps to see this article so I know what I am facing and what to ask the doctor.


almost 2 years ago, said...

my wife can't walk (as of very recently).I have a friend staying with until Tuesday morning 10/28. My wife has had a few fecal accidents recently. When I am alone I can't hold her standing up and wipe and clean her like when our friend has helped me by holding her up straight. I am her caregiver only and no help. Any suggestions? Thanks for your input.


over 2 years ago, said...

My husband's Parkinsons has worsened...and now diagnosed with PD Dementia/Lewy Body Dementia. I think this topic will be part of our lives sooner that I would have hoped... I did get some good ideas from the article....


about 3 years ago, said...

how to stop my mother from digging in her pull-on then smearing the feces or hiding it in drawers or stuffing it down sink...she refuses to sit on toilet without crying or struggling to get off.


about 3 years ago, said...

The person I care for has a BM sometime during the night or early morning and I'm greeted with a full diaper in the morning which is not diahrea just regular. There are days she doesn't have a BM which gives me somewhat of a break but all the suggestions mentioned above are no help to me. She's incontinent and does not use the toilet at all so scheduling is not an option.


about 3 years ago, said...

I found that the depends work well and I cut off a portion of the 5 inch elastic top so its more like 1 inch and a pair of panties which has helped keeping her rash free from the material that doesn't breath well. My wife is petite and now 59 years old is a walker and up most of the time. I have found that if I put her on the toilet 5 to 6 times a day especially before I lay her down for bed - I haven't had to clean up floors, her clothes or linens ( knock on wood ) for quite some time ... Also Sarna Lotion works great on rashes but really smells strong but really works quickly and I have found that Ca-Rezz cream which smells nice helps with moisture areas that are getting red


over 3 years ago, said...

Part of the problem is that people refer to incontinence products as "diapers" instead of adult underwear. It's no wonder aged ones "refuse to wear diapers." When you change the label to something that carries no shame with it, adults will feel less resistance.


over 3 years ago, said...

well i have a female with fecal incontinence and need to know what products to use for her at night... she tends to take her clothes and her underwear off and cause a mess on herself and her surroundings. i need help ... mornings are a nightmare.


over 3 years ago, said...

esco198025....I'm sure you won't be back to read this comment, but i think you should replace "adult diapers" with briefs or another term. Calling an adult's underwear a "diaper" is just not appropriate. Just saying.


over 3 years ago, said...

MALONINC, please stop referring to these products as 'adult diapers.' I'm sure you don't mean any harm, but people come to this forum for help and encouragement. I think that term is inappropriate Thank you!


almost 4 years ago, said...

I am 57 years old, and thought I had a stomach flu, It's true something started this, and maybe it was a flu bug, but now, I have no warning when a bowel movement is comiing. just last night I took 3 baths, Had no warning while I sleep I did wake to a wet cool feeling when I turned over, and had messed my underware, and P.J.'s.. of course the underware was very full. I had been to the doctor that day whie problems with my stomach and he said I just had a bug and to take Immodoim I D and other medication and to drink Pedialite which I have, but after this, I don't know if I should call a Gastro doc or call my family doc back.. Scared now, never expereienced this kind of embarrasment before, Even husband was in shock. But supportive. What is going on?


almost 4 years ago, said...

I AM WRITING ABOUT GOING PEE AND YOU CANNOT HELP IT. YOU WEAR A PAD BUT SOMETIMES IT IS NOT OFTEN BUT SOMETIMES IT IS. THEY SAY THERE IS SOMETHING YOU CAN DO FOR IT LIKE AN EXERCISE BUT I DO NOT UNDERSTAND WHAT IT IS. CAN YOU HELP?


over 4 years ago, said...

my husband is just now starting to have incontinence. He does not have any issues with wearing adult diapers, but my problem is changing him when he has a bowel movement in them. He eats a normal diet so has normal stools. It is rare that he is incontenint of stool but on occasion, he doesnt realize in time he needs to use the bathroom. He is still able to walk on his own although he is unsteady at times. What is the best method for removing his soiled diaper.


over 4 years ago, said...

For folks who refuse to wear diapers to begin with, I had luck introducing them to the products referred to as protective undergarments because these are more like pull-on underwear. Now, sometimes these aren't the best option (esp for fecal incontinence), but you are sure as heck gonna avoid carper and furniture accidents and after the Protective Underwear are being accepted, you can surely change to a more appropriate brief. Tranquility makes a really absorbent pull up so if you choose a good enough product from the start you may have better luck than you've bargained for.


over 4 years ago, said...

Like DragonFly, my father is refusing all solid foods and is subsisting (quite well, actually) on Ensure and pudding, neither of which have any fiber, and was having weekly episodes of fecal incontinence. He would wear diapers for the 24 hours or so after each episode, but then would insist on returning to boxers. His doctor suggested adding fiber to his diet. We were able to bulk up his stool, and eliminate most of the fecal incontinence, by adding fiber (Benefiber) to his Ensure, and by offering him daily milkshakes with bananas or peaches added in. We started seeing improvement with 9-12 grams of supplemented fiber. We have all been delighted by the condom (external) catheter, which has solved the urinary problem. For whatever reason, Dad finds this more "dignified" than the diapers.


about 5 years ago, said...

my mom in law dosent realized when she has a bowl movment or pees in her dyper. she has dementia, and only, dose this at night while she is sleeping. her doc said in sleep her muscles relax. during the day she might pee, once, when I take her to the bathroom,every other time she dose not go.She is on an ensure diet. thats ALL she will consume. if it wasent for her ensures, she would not be with us today.