Sun 01, Jun 2014
Gerard* was cleaning up about 25 of his mother’s faecal incontinence accidents each year until he spoke with continence nurse Lisa from the National Continence Helpline.
As his mother’s carer, Gerard cleaned up an average of 25 incidents of faecal incontinence each year for five years (between 2006 and 2011).
A retired librarian, Gerard kept meticulous records in his mother’s bowel chart and followed closely the advice provided by the family doctor ever since his mother, then in her mid-80s, began to lose control of her bowels.
The medical advice was to treat her chronic constipation, which had become so severe it was causing faecal overflow (which occurs when the bowel becomes so compacted that liquid faeces forces its way past the blockage). She was prescribed softening agent Coloxyl and bowel stimulant Senna.
On this medication, Gerard found his mother was having strong bowel motions at odd times of the night or day, most often when he was on his own.
That first year, his mother had 24 major incidents of faecal incontinence.
For the next four years, Gerard managed his mother’s incontinence as best he could, her condition becoming further compounded by dementia. Her constipation worsened and enemas were also prescribed.
An increasingly exhausted Gerard had to then manage his mother’s severe chest infection, which rendered her virtually infirm.
“This meant that all her transfers could only be achieved with a hoist. I was at a loss to see how I would be able to cope anymore,” Gerard said.
In desperation, Gerard phoned the National Continence Helpline, and spoke with continence nurse Lisa.
“Lisa explained that there had been significant UK studies on the long-term use of osmotic (water-absorbing) laxatives, and that they could be a gentler and more positive approach to treating her constipation,” he said.
Lisa explained that Senna could cause cramping. She suggested he take the research information to his mother’s GP to discuss the suitability of osmotic laxatives.
She also gave Gerard a basic overview of the body’s natural rhythms around toileting so he could take advantage of the most likely times his mother’s bowel would open of its own accord.
“I recommended toileting for the bowels half an hour after breakfast or dinner to take advantage of the gastro-colic reflex. This reflex occurs after eating or drinking, and the bowel moves its content along more strongly at these times. So it is much more likely that a good bowel action will occur,” Lisa said.
She also emphasised the need to adhere to the recommended bowel and medication regime as a lifetime plan.
“In a situation like this, where a person’s bowel has slowed down permanently, it is really important not to stop the bowel medications when it appears the situation has improved. The person will only become constipated again, and the accidents return,” she said.
Lisa also advised Gerard to make sure his mother kept up a good fluid intake of between 1.5 and two litres a day. She said the addition of dietary fibre was not recommended for someone with a slow bowel, unless they were taking in plenty of fluids.
“It is like having a dry mix of cement inside the body, and adding more dry ingredients into the mix,” she said.
Since Gerard phoned the Helpline, the number of incidents his mother experienced significantly declined.
“I don’t think I could overstate the gratitude I feel towards Lisa and the Helpline service,” Gerard said. “The advice received was crucial, and I certainly won’t hesitate to use the Helpline in future, nor would I hesitate to recommend the service to anyone with continence needs.”
For information, advice and resources on bladder and bowel health, phone the National Continence Helpline on 1800 33 00 66