smilebeth Posted March 2018
I feel so horrible but don't want to do some things.
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My dad's home health help has quit or can't come. He won't hire an agency because one treated him bad years ago. He hasn't had a bowel program this week. I am going down tomorrow. I have bathed my dad when needed, changed clothes, all of those things. But the bowel program is not something I want to do. I know my dad changed my diapers, I've changed my kids diapers. I will do my best. My dad feels bad but feels like he is going to poop his pants. My dad has a spinal cord injury. I will do what is needed but sometimes I wish things were different.
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and bring her by. Or tell him you can't do the and you've invited her come by and demonstrate. And let her teach you. If you have the money, go on a two week vacation and pay her to take your place while you're gone.
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I did this for my dad when he was dying of Mesothelioma in 1974. Something you didn't mention is you have to be careful and not hurt the Prostate because it caused him a lot of pain. My dad's mind was pretty well gone at this point, that is why his bowels were paralyzed. He was in this stage only a few weeks and we knew he was at the end of his life. He was on heavy morphine which made him constipated and the cancer was in his bones, so I had to be careful there also.
I don't blame anyone for not doing it. I never thought about hiring someone to do it. If I had, I would have tried to hire it done. In my culture hiring someone was never thought of. Of course back in 1974 a lot of things were different.
Unfortunately a very common problem as we age.
Llamalover I don't think it was Mom's olfactory sense that was going. it sounds as though she has or had chronic diarrhea and when the urge suddenly came on she did not have time to get to the toilet. you can't wait you have to run at the first growl.
Explosive poop does go everywhere on the floor up the walls under the toilet seat and many elderly just don't have the strength to clean it up. Mostly it is not deliberate unless they make a habit of finger painting.
A friends MIL comes to mind. When they visited the house smelt of pee and MIL did not wear underwear. i explaned because she was so obese and debilitated she just could not get her pants up and down and on her way to the bathroom just leaked and was something she could not help. Friend was quite shocked she thought MIL was just being lazy.
Of course, going digital, was a last resort. From mild stool softeners and laxatives to mag cit, nothing worked. Eventually Lactulose, which was eventually effective. But even then, it didn’t work within a reasonable time frame. Eventually, my last resort was the ER. The nurses there, where as not jumping up and down with joy to take this on, were fantastic in their attitude. They kept checking on her until the Lactulose succeeded. I had told the ER how there hadn’t been a BM for a week and that MS was the reason why. With this info, they checked her into the ER and took over. It was medically necessary by their definition, and Medicare handled it.
I don’t know if you’ve been able to get a prescription for Lactulose but I’d check with your doctor. I’d also see if your local ER could be a short term option.
Methods for Emptying the Bowel;
Manual Removal
(my note: You, the caregiver, physically remove the stool from the rectum-picking it out, so to speak.)
Physical removal of the stool from the rectum. This can be combined with a bearing down technique called a Valsalva maneuver (avoid this technique if you have a heart condition).
Digital Stimulation
(my note: You, the c/g, put your gloved finger in the rectum and move it around.)
Circular motion with the index finger in the rectum, which causes the anal sphincter to relax.
Suppository
(my note: You, the c/g, pushes the suppository into the rectum with a gloved finger.)
Dulcolax (stimulates the nerve endings in the rectum, causing a contraction of the bowel) or glycerine (draws water into the stool to stimulate evacuation).
Mini-Enema
(my note: You, the c/g, insert the tube of the enema bottle into the rectum, squirt the liquid in and remove the tube.)
Softens, lubricates, and draws water into the stool to stimulate evacuation.
Bowel Programs
Most people perform their bowel program at a time of day that fits in with their prior bowel habits and current lifestyle. The program usually begins with insertion of either a suppository or a mini-enema, followed by a waiting period of approximately 15-20 minutes to allow the stimulant to work. This part of the program should, preferably, be done on the commode or toilet seat.
After the waiting period, digital stimulation is done every 10-15 minutes until the rectum is empty. In order to avoid damage to the delicate rectal tissue, no more than four digital stimulations should be performed in any one session. Those with a flaccid bowel frequently omit the suppository or mini-enema and start their bowel programs with digital stimulation or manual removal. Most bowel programs require 30-60 minutes to complete.
Bowel programs vary from person to person according to their individual preferences and needs. Some people use only half of a suppository, some require two suppositories, and some use no suppository or mini-enema at all. Some choose to do the entire program in bed, while others sit on the toilet from the beginning. Some find that the program works better if they can eat or drink a warm beverage while it is in progress, others find that this is not helpful. What is most important is that you discover what works best for you.
(Taken from SCI-Info-pages website for quadriplegic and paraplegic persons.)
OK, now does anyone think an adult child should be doing ANY of this to their parent?
I'm another nurse voting "NO" to your dad's demands. Just say no. Mean it.
Hire a c/g or aide from an agency, use "therapeutic fibs" by saying she's a friend of a friend (not connected with an agency) and have her complete the task.
Sorry if this is too much info for some.
Bowel management after a spinal cord injury is not the same as toileting, it is a whoooole different level of care.
Oh yeah! And I thank God every day that I don't have to deal with that - but my neighbor does and you're right - a whooooole different level of care. Starting with suppositories. And she's been doing it for 5+ years now.
It may help that my sister and I were trained on how to do bowel program by first RN's and then CNA's at spinal cord injury rehab. We agreed we would help and become trained in all care as a condition of my dad entering their program. First it was done in bed, with my dad lying on his side. Then after a few weeks when he was strong enough to sit up for periods of time, in a commode chair.
I was very upset at first, seeing my dear father in this way. He was so humble and frail... I was angry at the nurses (in my mind) for always gently pressing me to do a little bit more of the program: first just being present in the room, then helping getting supplies, then watching, then another task, etc. But the wonderful attitude of the nurses and aides helped so much. One fabulous nurse had bowel program down to an art form, including a neat folded towel on the floor for the family member to kneel on and suggestions about watching an interesting TV show at the same time. He also told funny (but not offensive) jokes. Another nurse told me that her priorities were air freshener and cleaning as you go along. Anyway, it was all very matter of fact and humane.
This isn't to say the OP isn't right to bow out of this task and make sure her father is getting appropriate care, etc. Just that from my perspective, having to help with bowel program hasn't been the end of the world.
If he wants to keep living at home and avoid a facility, which I understand, he has to accept that you have limitations. Having you exhausted and overwhelmed is not in either of your best interests. I don't think they understand just how physically, mentally, and emotionally draining caregiving is. Try not to get started doing it - easier to not do it from the start than it is to stop - they come to expect things very quickly.
You're allowed to have limits.
Bowel management after a spinal cord injury is not the same as toileting, it is a whoooole different level of care.
I might chat with her and ask her those questions, since if she is wrong, it could have substantial negative consequences to a senior, alone in his home. Good luck with this.