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Behavioral Treatment of Fecal Incontinence for People with Dementia

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Updated: September 18, 2006

Toilet trip program

Decide on cause of fecal incontinence in Alzheimer's
Behavioral programmes can be extremely effective for improving incidents of fecal incontinence. Before you can begin to deal with it the number 1 priority is to find out the causes of the fecal incontinence so that the best treatment can be selected.

Remember, people with Alzheimer's can get sick and do suffer from other diseases too. Alzheimer's may not be the cause of fecal incontinence. Treatment of fecal incontinence is obviously determined by cause.

  • Fecal incontinence affects many people who have Alzheimer's disease.

  • Fecal incontinence can occur at any stage of Alzheimer's disease.

  • Deciding whether the inability to control his or her bowels is a communication difficulty, a result of confusion or from a disease will obviously change the emphasis for a successful treatment strategy. However, if you (and your doctor where appropriate) decide that fecal incontinence is caused by someone's confusion and inability to act to needing the bathroom then you can put into place an effective programme of toilet training.

    Establish a baseline of current toilet behavior
    It is important to establish the current way things are so you need to keep a diary of toileting habits for 3 days.
    Records required:

  • Record the time of any normal bathroom trips

  • Record the incidents of bowel movements. State whether the person was fecal incontinence or continent.

  • Record whether the person you are caring for asked or told you they wished to void

  • You can keep your diary to refer back to. You will need to do this to establish whether the behavioral toileting programme is effective.
    The new toileting pattern should show results after a couple of weeks.

    Toilet/Bathroom programme for fecal incontinence
    Begin your Timed Toilet Trips.
    You have to decide on the time frame depending on previous patterns of fecal voiding highlighted in the diary. If a person with Alzheimer's has a regular time to pass feces then it will be important that the person is taken to the bathroom at that time. However when someone with Alzheimer's has fecal incontinence a regular bowel movement time has been disrupted and lost for many reasons-confusion, disrupted sleep, prolonged bed care etc, etc.

    Toilet/bathroom programme
    Every 2 to 4 hours take the person to the toilet or help them onto a commode.

    Orientate them e.g.“Dad I'm taking you to the washroom. “Mrs Bouldon we are at in the bathroom now, try to go”. Be reassuring. Try to maintain dignity by giving some privacy. Do not keep them in the bathroom or on the toilet too long.
    Praise any positive results. Reassure the person that their behavior is appropriate.

    Keep to as rigid a timetable as is practicable. Because you are targeting fecal incontinence you will be able to change the amount of trips to the bathroom once you establish the best toileting programme for that individual.
    Night toileting should be maintained on a regular time basis too.
    Consult your diary to decide the time frame. Think about a 4 hourly schedule to allow for a good sleep pattern. Remember is important to maintain regular toileting habits even at night. It can help with restlessness, behavior problems and assist with general comfort.

    Measuring success of a fecal incontinence behavioral programme and Alzheimer's disease
    This programme will, of course, assist the person with Alzheimer's. It will help improve the life and stress levels of the caregiver too. The programme should be on-going, a permanent tool for caregiver's to use to improve toileting habits of someone with Alzheimer's, their comfort and pleasure of life.

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