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Elderly Mum and Toilet Issues - Carers UK Forum

Elderly Mum and Toilet Issues

Share your ideas about the practical side of caring.
I care p/t for my mother, who is 86 and lives alone. A carer calls in every day from Mon-Friday, while I cover the weekends.

Mum has several health issues, none of them too serious, but together they make life difficult. Mum has always been rather negative about things and suffered from spells of depression throughout her adult life (currently on anti deps). Mum has always has something of a nervous stomach, so that if she was worried about something she'd have an attack of IBS. Mum also has ulcerative colitis, a hiatus hernia, acid reflux, and difficulties swallowing solid foods so is on a mainly liquid/soft food diet. So, problems with food, at both ends.

Mum has had spells of incontinence over the past couple of years - mostly just urine but sometimes faecal too. She wears incontinence pants but she doesn't change them frequently enough and will often sleep in dirty panties, rather than go to the toilet to change them. This is worrying and also frustrating, as she has no real mobility problems so there is no need for her to sit in her own mess for hours - maybe this is a sign of dementia? We've talked about these problems and Mum claims she doesn't always receive a signal, or says that by the time she realises she needs to go it's too late. Mum's always been quite lazy, with a tendency to put off doing unpleasant things, so that doesn't help. I'm wondering what to do about this issue, as it's not going away. Image

On Friday she had to go to an eye appointment, just minor stuff about having her second cataract removed. I explained that it wasn't for the op, just checks/taking swabs, but she still worried herself to death and hardly ate anything until the afternoon. On Saturday I arrived at 4pm to take her to see Dad at the care home (it was his birthday), but on my arrival I was met with an awful stench and found her sat in her own mess. Image I got her straight up to the toilet, then into the shower - for once she didn't resist. By the time I'd finished cleaning her up and drying her hair, then cleaning the toilet, it was time to go and see Dad - alone as she wouldn't leave the house, for fear of further mishap. Her bottom was red raw and the poo had travelled into her bra too, so she must have been sat in it for HOURS! Image I asked her why she was in such a state - what was she so worried about? She said she is constantly worried about the second eye op. The thing is, when she had the first one done 2 months ago she claimed to feel no pain at all, but said she'd been nervous as the consultant kept shouting at her to keep her eye still. Every time Mum has spoken of her worry about the second op, I remind her that she had no pain with the first one, but she seems to have forgotten it all and built the whole thing up in her mind. The next op is 2 weeks away, and I don't want to cancel it, as she could go blind in that eye because the cataract is quite advanced, the consultant said.

I wonder if she ought to move to a smaller place, as the main toilet is upstairs, via a large hall, and the downstairs loo is also too far to reach quickly enough (via large hall and large kitchen). Maybe she would be better in sheltered housing, in a small flat where the toilet is close to the living room? Or maybe she'd be better off in a care home, with lots of regular meals and carers prompting her to visit loo/change panties?

If I bought a commode, I think she'd refuse to use it, even if it was right next to her - she's that illogical she's rather mess herself! It's so bizarre and so worrying. She always says she wants to stay in her own home, but I think any benefit of staying there is outweighed if the toilet's too far away for her to get to quickly. Meanwhile I will try to get more frequent carer visits, as the longer the time between visits, the longer the period she may be wallowing in her own mess.

Any advice welcome. Feeling so worried now.

(On the plus side, Dad enjoyed his birthday. Image Dad looks 10 times healthier than Mum now, which is making me think I can't let this problem ride much longer.)
Hi SheWolf
What a mess, quite literally. No practical advice to offer, so have a great big cyber hug instead (((((((((((((())))))))))))))

It could be your mum is right, she's not receiving signals in time, this does happen. But it does not explain her sitting for hours in her own poo if she's reasonably mobile. And how on earth did poo end up in her bra?????
I can imagine after several hours poo leaking and working it's way downwards. But upwards! Unless your mum somehow has gravity defying poo, she must have put it there herself. Perhaps inadvertently, while trying to remove them? Does she have problems with her hands, arthritis perhaps, that your mum's not admitting to, or possibly doesn't know about herself.
That last bit sounds weird, so I'll use my mum as an example. I've realised lately that mum often can't communicate her pain properly. She recently took to lying in bed all day saying it made her feel better. Despite questioning her, she wouldn't specify why, just that it did.
She'd never done this before so I called the doc in. Mum swore blind that she was in no pain whatsoever. And when the doc prodded and flexed her bad leg, mum gave no signs of pain either. Yet when the doc gently pressed on and around her guts she was wincing like mad. Turned out she was severely constipated, probably from the meds.
Once I knew that, it became blindingly obvious why mum preferred to be in bed all day, lying down straight out, rather than scrunched up sitting in a chair putting pressure on her overloaded guts. But she never once mentioned that, despite all my questioning.
I'm now fairly certain that if I'd specifically asked her "do you have nasty discomfort in your guts? Is that why you prefer lying down?" she's have said yes. But I asked a general question, "Whats wrong, mum?" and for some reason she couldn't be specific with her reply.
I've noticed this her not noticing stuff in other things. I'll notice her licking her lips and ask her if she's thirsty. She'll say no, she's fine. But I'll get her a drink anyway. Afterwards, she'll say,"That was lovely, I was so thirsty." All in the space of a few minutes!
I'm wondering if your mum is suffering from something similar? Perhaps her mobility is causing her more problems than others, perhaps including herself, realise? Maybe that might explain why she was prepared to lie in her own poo for so long. It wasn't that she wouldn't do anything about it, but that she couldn't.
The fact that she made no fuss at all about you taking her to the shower indicates to me that she was very relieved to get clean again.

Have you spoken to your mum's doc about your mum's possible dementia? You could request a home visit under the guise of it being a NHS requirement to check over all people 80 plus. I did that for mum; an idea I nicked from someone else on this forum. Mum would never have agreed to be tested otherwise; it worked! Just make sure the doc knows before hand the tactic you're using.

Regarding her fears about the eye surgery, I'd be even worse than your mum about it. I'd have less fear about undergoing a triple heart bypass than ANYTHING to do with my eyes, I'm that paranoid about them. So I have total sympathy for your mum on that one.
Rather than just reassuring her that everything will be fine, have you tried pointing out that the very worst that could happen is that the operation doesn't succeed, and she'll be blind in that eye. However, she's a 100% certain to be blind in that eye anyway if she doesn't have it. And if the operation is a success, which it is 99.99% likely to be just like the last one was, then she gets to keep her eyesight. In other words she has nothing to lose by undergoing the operation, and everything to gain.
If I were in your mum's position, that's the only kind of reasoning that would comfort me; that I have nothing to lose, so I'd better have that operation.

Glad your dad had a good birthday. You don't think your mum did all that poo stuff to avoid seeing him? No, that's just too extreme for words. There are easier ways, like pretending to have a bad headache, or something.

I've now got about an hour before mater and pater awaken. See if I can get some birdie shots in.
Chow for now

Sajehar X
Two brief thoughts - if your mum gets so anxious about things like hospital appointments and so on, can you simply not tell her about them until the moment comes, so she doesn't have time to fret? You just pack her into the car and get her there, fait accompli?? Maybe you could tell her that, say, the NHS has a very long waiting list for whatever it is the doctor has told her she needs, to put it out of her mind until 'next year' (or whatever) and then when you whisk her off to her scheduled appointment, you tell her that you got a call saying they suddenly had a cancellation, and you grabbed it for her! ???

Second, could she have some anti-anxiety meds (I hate to recommend my favourite Diazapam, but it certainly makes me fret less!!!)

Re the soiling - very, very difficult (and potentially dangerous, as she could be getting faeces onto the fingers, and thence into her mouth, for infection????)(or into any open sores on her, as well!) . As I was reading, I immediately thought 'commode'! But no, that won't work either, you say. Any chance you could install a 'portaloo' indoors instead, nearer than the current loos???? Just a thought! (I think you can get something called a composting loo that eco-warrior use to avoid sewage systems, or perhaps whatever they use in caravans???)

I have to say, from what you are saying, that getting your mum into a home may be the only realistic way forward. If, as you say, your dad has so much improved (hooray!), that might happen to your mum, too. And it would give you a much easier life....

Would coaxing her into staying there for a respite (or, perhaps, to 'spend a bit of time with dad'?) would be a means to achieve that??? And gradually turn 'respite' into 'full time' as she gets usedto the idea and starts to enjoy the comforts of being in a home?

Sorry if I'm just suggesting things you've already thought of and discounted - all the best possible as ever, Jenny.
Hi Everyone,

Thanks so much for all your responses - it's always great to get feedback and suggestions from other carers.

Sajehar, I think Mum has some sort of dementia, as her short term memory is getting worse and she's so illogical about certain things. On her last MM test she scored about 18/20, but then again some little things she does make me think she has the start of dementia. For instance, today I told her I was going outside to do some gardening, but when I came back inside a while later she looked a bit surprised and said she thought I'd gone home. At this stage I'm not overly fussed about seeking a diagnosis (more tests and what could they really do anyway?) but I've decided to start writing things down for her as her memory is so poor.

Jenny, I like your portaloo idea! Image Mum's hallway is massive and would accommodate one of those, but it depends what type of toilet could be used inside. I don't like the idea of a chemical toilet, because of the splash risks, so I need to research on the different types of toilets. My husband told me that some caravan toilets that have a tank of chemicals underneath the toilet bowl, and they actually flush, then everything passes into the tank below to be broken down. Maybe it would be like having a downstairs loo, but minus plumbing and with a degree of privacy.

Jenny, good thinking about not informing her of the appointments beforehand, but unfortunately she tends to open letters from the hospital before I can get to them.

Today Mum was sat in soiled pants again, when I arrived, about 2.30pm. Mostly just pee this time, so not as bad as yesterday. Worryingly, all signs indicate she'd had virtually NOTHING to eat or drink since I left her yesterday evening, at 7pm. I suspect she was anxious about a repeat episode.

After she'd been to the toilet, got cleaned up and changed, I made her a hot drink and had a long chat with her. She admitted she had been nervous about seeing Dad, as she just didn't feel like going, but also said again how worried she was about the eye op. We talked through her worries and I reminded her that she is going to have sedation next time so even if the consultant shouts at her she'll not feel worried, just relaxed. She was also worried about all the walking - it's quite a walk from the car park along lots of corridors, so I said we'll use Dad's fold up wheelchair. That seemed to reassure her, then I wrote all this down on paper in large letters and made her read it aloud, then placed the note next to her chair and told her to read it again whenever she feels worried about the op.

We also discussed getting a commode. To my surprise, she actually said it might be a good idea! I asked if she'd prefer it to go in the hall or the lounge - she said the lounge, so it's near to her. I said it's well worth a try and she doesn't need to worry as somebody else can empty it for her, but I made her promise that she will use it, and said that if I arrive there to find her sat in her own mess, with an empty commode just 3 feet away, I would not be pleased (though I have the feeling that may well happen - but I think it's worth a try). So, the plan for now is that I get a commode and maybe some kind of room divider to screen off a corner of the room, then hope for the best. Commodes don't cost much and it could help get Mum over this tricky pre op phase.

Sussex - I share your concerns about chemical toilets but I am grateful for Jenny's suggestions. When somebody responds with their suggestions, I don't expect them to be an expert on all the technicalities of every item of equipment they might suggest - I'm just grateful that people care enough to try to help me.
I forgot to add, we also discussed Mum going into a care home for respite, for 2 or 3 weeks, after the op. That would take the eye drop burden off me and the carer, and also give Mum a chance to experience a room with an en suite toilet just a few feet away - she'd have no probs getting there quickly. Mum is thinking about it.

There is a room available at Dad's care home, at the other side of the building, so she'd not have to see him very much. The home has the advantage of being familiar to Mum, with friendly staff, and Mum likes the owner. The disadvantage is that Dad lives there! (Sounds cruel but their marriage wasn't happy - see my other posts if you're new here). I will keep this idea on the back burner, as a trial period could be good to make Mum less fearful about the future (all old people seem frightened of ending up in a home), and it would be interesting to hear what the care staff make of her. If the trial went well maybe she could go there again if/when her needs grow. I don't intend to force her, provided that we can sort out the toilet/hygiene problems.

I made a point of cutting her nails today, as the longer the nails are the more nasties might build up under them. The way things are going, Mum could easily get a UTI, so I will get the commode asap and hope she uses it. However, I can't change her mindset, which is the main obstacle to keeping her healthy.
Sussex, you did help - you confirmed my own fears about chemical toilets (which I have no experience of). Also, I think you're right about the UTI risk, but I also think Jenny's point about the risk of infection through ingestion of faecal matter is valid too, because in situations like this it's quite possible Mum could end up with faecal matter under her nails etc. So, good advice from both of you, and although you offer different viewpoints, I am grateful for both.
"Sussex - I share your concerns about chemical toilets but I am grateful for Jenny's suggestions. When somebody responds with their suggestions, I don't expect them to be an expert on all the technicalities of every item of equipment they might suggest - I'm just grateful that people care enough to try to help me."

She Wolf, thankyou.

KR Jenny
Thanks Sussex, I need all the help I can get right now. So far as UTIs are concerned, prevention is surely better than cure, but much of that situation is in Mum's hands - she is choosing to wear soiled panties. Also, I think she is drinking less, in order to avoid toilet issues, so that is also a risk factor.

I never thought I'd welcome the idea of a commode, or that Mum would agree to use one, but if it stops her sitting in her own mess it has to be a good thing. I'm still not convinced she'll use it, but it's a possible quick fix so got to be worth a try. Now debating whether to get one on wheels or whether a more solid one might give her the confidence to use it. Hopefully with the lid down the smell won't be too bad, esp. if it's just pee, but I've told her not to worry about doing number 2s in there too if necessary, as we can flush it all down the outside loo. Whole prospect is daunting to me but after seeing the state she was in yesterday I've got to do something. However, if she doesn't co-operate I think she may have to go in a home eventually, where the carers will prompt her around the clock.

PS: You're welcome Jenny.

PPS: Off to view the commode club thread... unchartered territory... frightened, very frightened...

PPPS: Sajehar, your avatar is great!
I suspect that when Jenny said a 'chemical' loo she was thinking of a 'macerating' toilet where the waste is liquefied - like the ones from Saniflo; see here http://www.saniflo.co.uk/. They can be fitted in a very small place - popularly the 'cupboard under the stairs'.

Shewolf - you should be able to get hold of a commode via your OT department, would save you the expense of buying one which your Mum may refuse to use in the end.
The Red Cross also provides an equipment loan service so worth checking there too.