Most people think dementia is only about forgetfulness, but there is so much more to it. One of the most concerning and challenging issues for caregivers is dealing with bowel and bladder problems. When you’re caring for someone with dementia, these issues can arise unexpectedly and can be overwhelming.

As someone who has been through it all, I’ve seen everything from emergency surgery for bowel obstructions to finding poop in unexpected places like small garbage cans and closets. These situations aren’t uncommon, and understanding how to handle them can make a world of difference. This article is here to walk you through the bowel basics and share some of the main challenges you might face with your loved one.

Dementia Poop Basics

As the body ages, everything slows down, including the bowels. Decreased mobility and aging cause waste to move more slowly through the system, which leads to constipation.

Constipation is defined as infrequent (less than three times a week) or difficult bowel movements, and it can cause a lot of discomfort for your loved one. They may experience abdominal fullness, gas, and cramping. Sometimes, constipation can lead to a bowel obstruction, which is a medical emergency.

In later stages of dementia, constipation can cause agitation because your loved one may not understand what’s happening or be able to communicate that they’re in pain. Keeping track of their bowel movements is essential to preventing complications.

Diarrhea

Diarrhea is a nightmare for any caregiver, especially when your loved one is incontinent. Diarrhea is frequent, loose, watery stools, and if your loved one is still mobile, cleanup becomes even more challenging.

If your loved one has diarrhea, it’s important to look for possible causes, such as medications, food, bacteria, or even artificial sweeteners. If diarrhea lasts for more than a few days, dehydration becomes a serious concern. Dehydration can lead to delirium, which is a severe condition. Contact your doctor if any of the following occur:

• Diarrhea lasts longer than two days
• Your loved one becomes dehydrated
• They have severe abdominal or rectal pain
• Their stools are bloody or black
• They develop a fever above 102°F

Learn more about dehydration HERE.

Incontinence

Incontinence can happen when your loved one no longer recognizes the urge to go to the bathroom. They may not even be aware that their bowels have moved. Recognizing their cues early on can help—some people get restless, pull at their clothing, or turn red in the face.

Once accidents start happening, it’s time to use incontinence products. There are many different types available, and finding the right product for your loved one can make life easier. Learning the signs and responding quickly can sometimes help prevent accidents.

You can learn more about toileting products HERE.

A Story from the Heart: A Difficult Day at the Restaurant

Let me share a personal story that you might relate to. I remember sitting in a cozy restaurant with my loved one who had dementia. We were enjoying a nice meal when suddenly I noticed that familiar smell… their bowels had moved while we were sitting there eating.  I felt the heat of embarrassment rising up my neck. I glanced around, hoping no one else had noticed. But I couldn’t just sit there. I had to act quickly and calmly.

Getting them up and to the restroom wasn’t easy, especially with them not fully understanding what was happening. Once we made it there, the cleanup began. It was messy and stressful. I was fumbling through my bag for wipes and a change of clothes, all while trying to comfort them, who was confused and upset. After what felt like forever, we managed to get them cleaned up and back to the table. But by then, I was frazzled, and the meal had lost its charm.

What I learned from that experience is the importance of being prepared and keeping a level head. I started carrying a “care kit” everywhere – wipes, gloves, extra clothes, and even disposable bags for soiled items.  And more importantly, I learned that even though these situations are embarrassing, they’re just part of the journey. We can’t always prevent these moments, but we can prepare for them and do our best to handle them with kindness and patience.

Understanding the different over-the-counter bowel Medications 

When bowel issues begin, caregivers often want to help but may not know where to start. Understanding the types of bowel medications can help you choose the right one for your loved one. Here’s a quick guide:

• Fiber:

  Adds bulk to the stool by absorbing water, but remember to push fluids to prevent blockages. Examples include Citrucel and Metamucil.

• Stool Softeners:

  Draw water into the intestines to soften the stool. Colace is a typical example.

• Stimulants:

  Encourage the intestines to contract and move the bowels. Dulcolax and Sennokot are common choices.

• Osmotics:

  Draw water into the large intestine, softening the stool. They may cause cramping, diarrhea, or nausea. Examples include Milk of Magnesia and Magnesium Citrate. Many contain Magnesia; it is essential to check with the doctor first if your loved one has heart or kidney failure.

• Suppositories:

  These are inserted into the rectum to stimulate bowel movements, often by softening the stool. Glycerin and bisacodyl (Dulcolax) are typical choices.

• Enemas:

  Inject fluid directly into the rectum to soften the stool and prompt bowel movements.

Establishing a bowel plan with your doctor’s guidance can help prevent constipation before it becomes a bigger issue.

Too Many Steps?

As dementia progresses, everyday tasks become more complex for your loved one. In the later stages, the steps involved in using the bathroom—finding the bathroom, recognizing the toilet, pulling down pants, sitting, pooping, wiping, and pulling up pants—become difficult or even impossible to coordinate.

So, if you are having problems in these areas, try to figure out which step is causing the issue and adjust your assistance accordingly.

Where Is The Bathroom?

Toileting problems can occur at any of these steps and usually do. For example, problems finding the bathroom may result in finding messes in the wrong room. However, making sure the bathroom is easy to find, closing all other doors, and adding locks may help.

If the problem is at night, ensure the bathroom is well-lit, and the rest of the hallway is dark.

They may fail to recognize the toilet. Many caregivers have found that their loved one used a small round garbage can instead of the toilet, even when it is right next to the toilet. Leaving the toilet lid open, using a different-colored toilet seat, and removing the garbage may help stop this issue.

Dementia Poop “Oh My It’s Everywhere”!

Sometimes, things can get even more complicated. Your loved one might remove their pull-up or diaper and poop on the floor. The situation can escalate if they then touch the poop, not realizing what’s happened. Many caregivers have shared stories about finding poop smeared everywhere.

In these cases, your loved one may have felt discomfort in that area and explored it with their hands, not understanding what was happening. To prepare, keep a manicure kit handy for cleaning under fingernails, and remember that soaking hands in warm, soapy water can help get rid of the mess. You can find them HERE.

Managing these types of issues requires creativity and patience. To prevent your loved one from accessing their pull-ups or diapers, you may want to consider using clothing that restricts access to that area, such as adult onesies worn backward.

Toilet Issues and Interventions

Toileting issues can extend beyond pooping and into the realm of fascination with flushing things. Many caregivers have spent a lot of money on plumbers due to their loved one’s obsession with putting things in the toilet.

I recommend keeping a single partial toilet paper roll in the bathroom. Otherwise, they may use a whole roll at a time. Another tip is not to leave wipes in the bathroom. Even though the label says you can flush them, they can clog your system. This video helps explain wipes in the sewer system.  https://youtu.be/rcfucpVNPOo

Another trick some caregivers have used is to turn off the valve behind the toilet to prevent flushing. One family started doing this after their third plumber’s visit for a clogged toilet.

Toileting Schedules

Having a toileting schedule can also help prevent incontinence episodes. Taking them to the toilet every 2 hours will help. Nursing has done this for many, many years.

Also, take a look at their diet. Giving them coffee or prune juice at breakfast can help wake up the bowels and get them moving soon after. These are natural laxatives and will help you keep them on a routine.

Toilet Issues and Interventions

Toileting issues can extend beyond pooping and into the realm of fascination with flushing things. Many caregivers have spent a lot of money on plumbers due to their loved one’s obsession with putting things in the toilet.

I recommend keeping a single partial toilet paper roll in the bathroom. Otherwise, they may use a whole roll at a time. Another tip is not to leave wipes in the bathroom. Even though the label says you can flush them, they can clog your system. This video helps explain wipes in the sewer system.  https://youtu.be/rcfucpVNPOo

Another trick some caregivers have used is to turn off the valve behind the toilet to prevent flushing. One family started doing this after their third plumber’s visit for a clogged toilet.

Cleanup Tips

Cleaning up after an accident is no easy feat. A handheld shower sprayer can help, and many caregivers find that bidets work wonders. Keep disinfectant wipes nearby to wipe down doorknobs and other surfaces. It’s also smart to have a cleanup kit ready with gloves, small garbage bags, and a jar of Vicks.

The Vicks helps mask the odor. Put a little bit in each nostril; it usually overpowers the smell. This is an old nursing trick that I have used for many years.

Know Your Limits

For many caregivers, dealing with toileting and poop issues is the hardest part of the job. It’s okay to recognize your limits. Some caregivers move their loved ones to a facility when they can no longer handle the cleanup. Only you know what your breaking point is, and it’s important to take care of yourself while caring for your loved one.