How do I best deal with Mom's incontinence?

5 answers | Last updated: Oct 26, 2016
A fellow caregiver asked...

My mother is 84 years old, and until about four years ago was a heavy drinker. She has dementia now, and even forgets the death of both of by brothers. My husband and I take care of her. She has gotten where she doesn't even try to go to the bathroom. I check on her often, but I do have a job where I work three days, 12 hours each day, and that is when my husband cares for her. She doesn't even know when she has soaked or soiled herself. I try very hard to keep her clean, but it seems to be a full time job. What do you suggest. She wears disposable underwear, but it doesn't hold it all. Also, she will not eat the good food I fix for her. She sneaks mayonnaise sandwiches.


Expert Answers

As Founder and Director of Circles of Care, Ann Cason provides caregiving, consulting, and training services to individuals and public and private organizations involved in eldercare. She is the author of Circles of Care: How to Set Up Quality Home Care for Our Elders.

I am sorry to hear of your difficulties with your mother. Even though she is dry from alcohol, she is wet with bodily waste, and you are left with dementia and incontinence frustration.

Drinking was an attempt to hide her feeling nature from herself. Now she doesn't drink, but she is stuck with an old habit. She does not feel. Feeling might hurt. She doesn't feel when she is wet. Wet and dry are all the same. In the same way, she would rather eat something bland like a mayonaise sandwich so she won't feel the bite and spice of delicious food or of life itself.

She may need treatment for depression or vitamins for poor nutrtion. For sure she needs more sense of boundary in her life. Could you help create it for her? She needs a daily schedule. For awhile take her to the toilet every couple of hours. Even if she does not go, wash her with a warm cloth and rub her bottom with a moisture barrier. Compliment her on her soft skin. Use a scented lotion and try to get her to select a fragrance she likes. Go to a web site like Tena.us. Tell them how much your mother goes and let them find the best incontinence product for her condition. She needs a product that quickly absorbs alot of moisture.

Also, if possible, as part of your mother's daily schedule, she needs to get out of the house. She needs to be engaged in some small way in the shopping for food and for its preparation. Could she shop with you and push the cart? Could she snap green beans? Could she peel an apple and slice it? Could she stir a cake?

There is a tendency with alcholic dementia to let one activity run into another with no space in between. There is no beginning or ending, just drifting on. Does she sit around watching t.v. and eating a sandwich without taking time to eat a proper meal? She needs a time to get up, to make her bed, get dressed, watch a program, have lunch, go for a walk, watch a program, eat a snack. Experiment with her. Make her choose her clothes. Or if you lay them out for her, make her choose a lipstick or a scarf or what shoes she wants to wear. Is there something that she cares about? if she eats a mayonaise sandwich what kind of bread does she prefer? Start where she is. Find one thing that will make the sandwich more uplifted: better bread, a good knife to spread it with or keeping it in a bowl with a lid instead of the jar.

On the days that you work could you get a personal care attendant to come for a couple of hours to bathe her, to fix her hair, and polish her nails? Or could your husband take her to the hair dresser? Or perhaps ask her to go out for an ice cream or for lunch?
If she is going out for something enjoyable, will she go to the bathroom first? Is your husband willing to change her?

It takes years to recover from a life time of heavy drinking. What does she do during the time she used to drink? Does she need an activity that is soothing for her. Consider going to alanon meetings which are free and help the family of people who drink.(Or are working with alcoholic patterns)

You have taken on a big project. Frustration arises because you are dedicated. Find a source of support for yourself so that you don't end up burned out and unable to "feel" like your dear but frustratingly wet mother.


Community Answers

A fellow caregiver answered...

Thank you Ann - You have described my step mother to a "T" as she had a drinking problem. She is now in a hospital but it is quite a struggle to get my father to understand what is happening to her. My father had to put my mother in the hospital 21 years ago as she had cancer and died 3 weeks later so he just won't let my step mother go. This has created all kinds of problems for my step mother and the care facility as she is constantly confused. My Dad is the only one she recognizes. She doesn't remember how to eat or how to walk. I had to work on my Dad to finally purchase disposable pants as she was constantly wetting and soiling herself after she was released from the hospital after falling and breaking her hip. Alzheimers is such a nasty disease. We can only hope for a breakthrough some day.


Frena answered...

since it's probably now impossible for your mother to even know she needs to get to the bathroom, let alone where the bathroom actually is, try a bathroom time schedule.

assume she needs 2-hour schedule minimum and get her to the bathroom. try, "Mom, let's go to the bathroom," which usually works better than "Would you like to go to the bathroom?" which tends to evoke the answer "No."

she also needs an extra visit for her poop schedule. you could probably figure out her most likely time for that. (i know, I know -- but would you rather clean up or would you rather just study her schedule?)

make sure she doesn't have a UTI, by getting a urine test done. ask her doctor, it's pretty easy and often they can give the results immediately. that causes a great deal of extra urine to flow!

if she needs changing in the daytime, and your husband is reluctant, you can just cut off the pullups and throw them in the big garbage bag.

have everything needed right there -- protective gloves, big garbage bag, baby wipes, new pullups -- and it's much easier to have her kept in greater cleanliness and comfort. and perhaps your husband could also be part of that.

as for the mayonnaise sandwiches, i'd say that's the least of your worries. a good diet probably won't change much at this point. you give her good food, and that's great. she sneaks her treats and, oh well.

great job! but don't forget to consider other care for her too. when someone needs full-time (and more) care, it's often when families could well consider residential care in a good place. don't listen to the horror stories on this site. do your own homework to find somewhere good. they're out there. even if you just use it for respite for your and your husband. that's your primary relationship to nurture.


Funlovingram2 answered...

My situtation is a bit different than those described above in that I am the sole caretaker for my 91 year old stepmother who is in the moderate/severe last stage of Alzheimers. She is bed-ridden and is unable to help at all in assisting with getting in or out of her bed or in her wheelchair. She wears disposable briefs and needs to be changed 5 or 6 times a day. I am very lucky, however, in that I do have assistance with aides 6 days a week for 4 hrs a day to allow me to get out of the house and take care of any errands or meet with friends or catch a movie. Once I'm home though, I'm in for the balance of the day/night until the next morning when one of my aides comes in. I'm also lucky in that my stepmother gets a bed bath twice a week and her hair washed once a week by the aides. Also, anyone who touches her, ie bathing or changing her soiled diapers, has the same reaction - she screams like she is being tortured or in pain. Someone said that its because of the nerve endings in her body and touching her affects her this way. Otherwise she is very pleasant and doesn't make a sound.

Like many of your readers, my stepmother doesn't know who I am or anyone else who comes to visit her. She does remember her mother, whose picture I hung in her room. She also can't really hold any kind of conversation and even has difficulty saying no or yes to any question you ask her. I don't feel angry or upset with her because she doesn't remember me because I know its just the disease.

Also, her eating has declined. She only likes juice, Ensure Plus, toast with butter and jelly on it, yogurt, cookies and vanilla ice cream. Otherwise, she has no appetite for any other kind of food. She does take a vitamin supplement because of her poor eating habits, which I have to crush up and put into her drink because she can't swallow any pills. Believe me when my stepmother first came to live with us, I tried everything I could to get her to eat more nutritional foods by pureeing the food but nothing worked.

I quit my job 2 years ago to take care of my stepmother and my husband,whose health started to decline. Sadly, my husband passed away a couple of months ago so now I just have my stepmother to take care of. In a way having to care for my stepmother has helped me get through some of the pain of losing my husband as I really don't have much time to think about much else but running the house and taking care of her.

If there is any advice you can provide me on what else I might do for my stepmother to make her more comfortable, especially when she needs to be bathed or changed, or any advice in general, I would really appreciate it. Thank you.


Frena answered...

i'm so sorry for your loss, and i deeply admire your strength and determination!

i suggest asking for a hospice assessment for her. it is very likely that they would consider her as a client because of the extent of her illness now. then you will get all the help, advice and comfort medications she would need, and the support you so much deserve.

hospice care will be completely covered by medicare and will provide enormous comfort and support for you too. ask her doctor to refer you to hospice and let them assess her. if her doctor resists, ask again for that referral. sometimes doctors resist hospice, but it is up to hospice to assess your mother-in-law. so it's worth pushing for.