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