Stages of Dementia and Fecal Incontinence: Part One

Dementia Incontenence resized 600My Mom and Dad grew up during a time when talking about bowel movements was a much more conversational topic because it was a not to be missed, daily (or twice daily) event. Seriously, they could have had their own reality TV show called “American Bowel Wars”!

Mom grew up during the great depression and Dad grew up in the early 1900’s and loved John Harvey Kellogg – yes, the Corn Flake guy. According to Mom, she was as regular as the sun rising. Dad was a once a day kind of guy, Mom was a twice a day kinda gal. Growing up, I was the “can we NOT talk about this?!” kinda of gal.

My parents were Northerners who moved to the South. I was born as a proper Southerner, and we just DON’T talk about these things. Not even with family members and definetly NOT around the breakfast table.

Just so you know, being “regular” in our home meant stewed prunes and Kellogg’s Corn Flakes were breakfast staples. Back then, I would never admit to my parents that I really liked stewed prunes, but now as an adult, I will openly admitt that boiled Sunkist prunes are actually quite delicious.

It is because of all the conversations from my childhood (and prunes), that it never dawned on me that my Mom could later have fecal incontinence. As Mom’s caregiver, I didn’t know that memory loss could affect her bowels.

Urinary incontinence, yes. But bowel incontinence who knew?

I will never forget when Mom’s stomach started growing. And growing…and growing. She was in the mid stage of dementia and still physically and vocally active. She was in a stage of dementia where she was still able to go to the bathroom by herself.

As her stomach grew larger, so did her pain and discomfort. Since Mom was in the mid stage of dementia she had a hard time letting me know what was wrong. At this point, her stomach looked like she was 6 months pregnant and she was grimacing in pain.

Mom has always been afraid of doctors so of course, when I made the appointment with her geriatrician she smiled at him and said she “felt fine.” One touch to her stomach and she was grimacing in pain – off to the hospital.

Fecal incontinence can be life threatening.

What started out as slight uncomfortableness soon became a hospital situation. Mom had a serious case of impacted bowels that resulted in a two week hospital stay.

During Mom’s hospitalization, I learned more than I ever wanted to know about Mom’s and the bowels of those who have memory loss. If you’ve read my book “Alzheimer’s Disease and Other Dementias: The Caregiver’s Complete Survival Guide” you’re aware that I have a major case of PTDD (post traumatic diaper disorder). So dealing with any form of incontinence is not a happy moment for me.

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Impacted bowels is a common occurance when a person has dementia. Since it is common, as a caregiver, I know that in many situations it’s avoidable.

Think about it – how many times have you gone on a holiday or swayed from your normal routine? For many of us, constipation occurs.

The difference is, for those of us without Alzheimer’s disease or other forms of memory loss, we can simply go to our medicine cabinet and take a laxative. Not so simple for a person who is in any stage of dementia.

There are many reasons for fecal incontinence: diet, lack of excercise, trauma, medication, altered mental states such as Alzheimer’s/dementia, anxiety and other medical diseases.

As a caregiver, you need to be aware that during different stages of dementia, things like appitite, food choice, excercise and liquid intake will change bowel movements.

A key part of caregiver support is education. An informed caregiver is the best caregiver. With that in mind, here are 5 tips to avoid fecal incontinence during any stage of dementia.

1. Check not only memory medications (Aricept, Exelon, Razadyne, Namenda and Axona), but also all medications that the person is taking. Speak to their doctor about any changes or concerns in bowel movements before starting or stopping any medication.

2. Make sure that the person you are caring for is getting plenty of fruits and vegetables. They are high in fiber and help with digestion. We made a cabbage soup for mom that she loved, and so did we because it kept her regular. You can also read more here on what to serve to your loved one with dementia.

3. Ensure your loved one is drinking plenty of fluids. Hydration is key to avoid constipation.

4. Movement is important to keep the bowels working, so any form of physical excercise is important. No matter what stage of dementia your loved one is in, any body movement will help avoid constipation. In the early and mid stages, this may mean continuing at a gym and developing a new excercise regime, such as walking, swimming, etc. As Alzheimer’s and dementia progress, consult with a physical therapist or doctor to tailor the excercises to your loved one’s capabilities.

5. No matter what stage of dementia your loved is in, when you are an Alzheimer’s Dementia caregiver you will need to be vigilent. Your relationship and your new knowledge of this situation will make a world of difference.

Do you have a question about stages of dementia or caregiving? Get honest answers from someone who knows the ins and outs of dementia care.

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