MANAGING INCONTINENCE

By Elizabeth Eby

As a caregiver you may have to help your loved one if he or she is not able to go to the toilet by him or herself. The first step in coping is to make sure your loved one understands that it's a medical problem, not a personal failure. The next step is to always respect his or her privacy. Discuss the problem with your loved one; be sure he understands that you are going to work with him on toileting and personal hygiene.

Then, like the Boy Scouts say, be prepared. Remember to locate the restroom the first time you visit a building and take along supplies including a change of clothing.

Keep a Journal

Keeping a journal recording times of bowel movements and foods that your loved one eats may help you identify patterns in your loved one's bowel activity. Usually three days of journal keeping is sufficient. Refer back to it and make adjustments to make it a more reliable guide.

Develop a Routine

Recording the time of day bowel movements occur can help you develop a routine. It can guide you to the right times of day (and night) to take your loved one to the bathroom or when to change a diaper. It may guide you to the best times of day to make appointments. Some caregivers use a behavioral approach, and take their loved one to the bathroom on a regular schedule around the clock.

Diet & Nutrition

It's important to maintain the correct balance of dietary fiber and liquid intake. Dehydration is a threat if bowel movements are loose or tend toward diarrhea. Some foods may stimulate bowel activity or density. A written record of what your loved one eats may point to foods to eat more often or those to avoid.

Talk About It

Difficult as it may be, talk to your loved one when you are about to take him or her to the toilet or change a diaper. Good communication will make it easier for your loved one to tell you when it's time to go or ask for help because he or she soiled a diaper or clothing. If he or she is not sensitive to bowel movements, you need to remind yourself to check in periodically and take him or her to the bathroom.

Toileting Etiquette

Privacy is important and must be respected at all times. Drape a clean towel around the diaper area when you are cleaning your loved one's body so that only the direct areas you are working with are exposed.

You might consider buying an inexpensive room divider screen in the event you need to change toileting in their room. This helps prevent the embarrassing situation of having people walking in and seeing everything.

Safety equipment such as railings and special toilet seats are available so your loved one can go to the bathroom alone, and stay in the bathroom alone. Just be sure he or she isn't sitting on the toilet for too long-it could be a sign of diarrhea or constipation.

Perineal & Genital Care

According to Caregiving at Home, by William Leahy, M.D. (www.caregivingathome.com), the perineum is the area between the anus and the urinary opening for a woman, or between the anus and the penis for a man.

When cleaning the perineal and genital areas, wear latex gloves to protect your hands from contact with body secretions. Use clean warm water, a clean washcloth, and a towel. Spread a waterproof sheet on the bed and ask your loved one to lie on his or her back.

• For Men

  Retract the foreskin if he is uncircumcised, then hold the penis by the shaft and wash in a circular motion from the top down to the base. Rinse the penis and then rinse the washcloth and wash to the scrotum and the groin. Rinse and pat him dry.
  Ask him to lie on his side and wash the anal area without contaminating the area you just cleaned. You may consider using another washcloth. Rinse and pat dry.

• For Women

  Wash from front to back, using single strokes. (Washing from back to front may spread contaminants.) First wash the center of the perineum and then, using a clean section of the washcloth for each stroke, wipe both sides. Then spread the folds of skin that protect the urinary and vaginal openings and wipe both sides and then the middle. Rinse the area in the same way. Then ask her to lie on her side as you wash and rinse the anal area.

Avoiding Rashes & Dry Skin

Several different skin conditions are associated with incontinence. Prolonged exposure to the acids in urine and feces in undergarments or diapers cause a rash. Soap residues left in the perineal area may also cause rashes. Bunched up or damp undergarments that rub on the skin are another source of irritation. Make sure you clean the entire area each time you are toileting, rinse well, and pat dry. Make sure undergarments are changed promptly and that the skin is clean and dry before putting on fresh underwear.

Handling Body Wastes & Incontinence

Wear gloves and put soiled diapers or bedclothes in a sealed plastic bag and then into a second plastic bag before removal from your loved one's room or bathroom. Dispose of your gloves when you are through.

When an infectious disease like influenza or a disease that weakens the immune system such as AIDS or cancer are present, it's important to take extra precautions against infection. Use a disinfectant and paper towels to clean any surfaces that come into contact with body fluids such as bedpans, urinals and toilets.