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  • Miriam Green

Incontinence


November is Bladder Health Awareness Month, according to the National Association for Continence (NAFC).

This is the first you’ve probably heard about it. It's true. I’m not making this up. Which makes what I’m about to write all the more poignant.

Bladder and bowel issues are a constant problem with many elderly individuals. According to NAFC, “one in five individuals over the age of 40 suffer from overactive bladder or urgency or frequency symptoms, some of whom leak urine before reaching a restroom.”

Add to this the problems associated with Alzheimer’s and, regrettably, you have individuals who may no longer recognize their body’s signs associated with needing to use the toilet, much less the ability to find and identify the bathroom as the place they must seek.

One of my favorite Hebrew prayers is what is known as the “bathroom prayer,” Asher Yatzar, which is traditionally recited after an act of excretion. It loosely translates as “Thank You, God, who formed human beings with wisdom and created them with openings and orifices. If one of these orifices were ruptured or one of them blocked, it would be impossible to stand before You and survive. Blessed are You, God who heals all flesh and acts wondrously.” Just so.

Despite wearing a diaper, Mom has unfortunately soiled herself several times this week. Today was no exception. After she was completely changed—including clean pants and socks—and sitting comfortably with us in the ward, Mom complained that she felt sick. What does it mean when someone with Alzheimer’s, someone who has lost touch with reality, tells you they don’t feel well? How do you get them to clarify what’s wrong in a way that you can assist?

We felt her forehead, rubbed her back, looked in her eyes. Finally, Mom said her stomach hurt. My dad took her back to the bathroom where she agreed to sit on the toilet (not an obvious outcome), and it became immediately clear that Mom had a bad case of diarrhea. When I informed the nurse, she told me that Mom had had diarrhea in the morning, too.

“Too much laxative,” one of the other aides mumbled.

“Really?” I asked. “Is that a problem?”

There is a fine balance in implementing appropriate bowel care for the institutionalized. First, you need a healthy, varied diet that includes vegetables, fruit, proteins and starches in good measure. Liquids are essential. It is easy for older people to become dehydrated, because they just don’t drink enough. In its extreme, it can cause dryness of mouth, lack of urination, headaches, dizziness, and more.

Every bowel movement is recorded on an individual’s chart so that the staff doesn’t miss signs of constipation. Often, to counteract constipation and keep an individual regular, a laxative is used. Except that, for whatever reason—the changing season, an unbalanced diet, a cold—the whole experiment can be thrown off balance.

The doctor gave us a small pill for Mom to swallow, a medicine called Stop-It. It makes stools more solid and less frequent by regulating muscle contractions of the intestine. This allows the bowel time to absorb water and produce a more solid stool.

As a precaution against dehydration due to the diarrhea, we pumped Mom with extra water and juice, which she doesn’t always like to drink (especially water as she tells us it’s “tasteless”), in the hope that all these measures would rid her of the discomfort of her stomach ache.

I returned later in the day for another visit to feed Mom a banana, which is one of the recommended foods for people suffering from diarrhea. (I love being close enough to her ward to go whenever I feel like it.) Mom was delighted to see me, though I was sad to find her sitting there in the main room staring into space. (I can’t wait for her new headphones to arrive! She needs her music.) She rejected the banana every time I offered it. But I was glad to see her in the same clothes as the ones that she’d been changed into in the morning. I just hope that the medicine she took doesn’t start the whole cycle again by pushing her towards constipation. This is an ongoing process. With God's help—and the assistance of a caring staff—it will all work out in the end...

Potatoes are such a mild food that they are actually quite good to consume if you’ve got diarrhea. I would suggest mashed potatoes as the ultimate soft food, but I wanted to try something a little more upscale. Plus, these babies are just so tasty.

Roasted Potatoes with Sun Dried Tomatoes

These potatoes are delicate and fragrant. They go well with any main course.

20 mini potatoes, halved

Water to cover potatoes

6-8 sun dried tomatoes, chopped

1-2 Tbsp olive oil

1 tsp dried garlic crystals

½-1 Tbsp rosemary

Salt and pepper to taste

Directions:

Place cut potatoes in a pan of water on a high flame and reduce to simmer once water has boiled. Mix oil and spices together along with chopped sun dried tomatoes. When potatoes can be pierced with a knife, transfer to a baking dish. Pour on oil mixture, making sure all potatoes are covered. Bake at 350 degrees F / 180 degrees C for 25 minutes or until potatoes begin to brown.

#adultdiapers #diarrhea #water #potatoes #roastedpotatoes #bananas

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