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Medical Forum / Diseases and Disorders / Alzheimer's / March 2007

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Night time fecal incontinence...

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alanryder@aol.com - 24 Mar 2007 15:27 GMT
My mother has had some episodes of this at night lately. Her stools
seem to be a bit loose. She has urinary incontinence all the time, but
this is new. She's in her late eighties and mid stage. I've been
trying to see if there's anything in her diet that might be causing
it.

Has anyone else dealt with this? Any treatments to help? I will have
to start reminding her to move her bowels before she goes to bed. Any
suggestions of what I might try? Would this be a gastroenterologist if
I wanted to have her checked? Any medication to help? Thanks!
Evelyn Ruut - 24 Mar 2007 16:09 GMT
> My mother has had some episodes of this at night lately. Her stools
> seem to be a bit loose. She has urinary incontinence all the time, but
[quoted text clipped - 6 lines]
> suggestions of what I might try? Would this be a gastroenterologist if
> I wanted to have her checked? Any medication to help? Thanks!

I am not a doctor, just some thoughts to offer.

I think it is a very good idea to suggest she use the bathroom before
bedtime.
When does she take her medications?
Are any of them associated with loose stools?

It probably wouldn't hurt to give her a bit of Pepto Bismol when she is
loose like that.

If I were you, I wouldn't want to put her through any kind of testing that
requires any kind of sedation.   Alzheimers and sedation don't go well
together.   In fact, you may already know that it often sets them back and
they never regain the cognitive skills they lost.

Does she get up at night and try to use the bathroom (in spite of the
incontinence) from time to time?   How about during the day?  It is always
possible that it is just the progression of the illness, but it may not be.
Signature

Best Regards,

Evelyn

Tumbleweed - 24 Mar 2007 18:12 GMT
> My mother has had some episodes of this at night lately. Her stools
> seem to be a bit loose. She has urinary incontinence all the time, but
[quoted text clipped - 4 lines]
> I will have to start reminding her to move
> her bowels before she goes to bed.

Remind me what she is suffering from? And what the effects are on memory?

Signature

Tumbleweed

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com

Mary_Gordon@tvo.org - 24 Mar 2007 20:56 GMT
You can take her to the doctor, you can try getting her to move her
bowels during the day or before bed, but you KNOW this is a "normal"
part of the progression of AD. First comes urninary incontinence and
next is fecal incontinence.

I doubt very much this is fixable, and once it starts, it gets worse,
not better.

M

Stage 6:
6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence
alanryder@aol.com - 25 Mar 2007 01:01 GMT
I called the Alzheimer's Association and they said it wasn't
necessarily related to Alzheimers and that it wasn't a given that this
goes with it. Even urinary incontinence they said wasn't necessarily
part of Alzheimers. I will do some further reading on it. Would you
have the link to your source? Thanks!

On Mar 24, 2:56 pm, Mary_Gor...@tvo.org wrote:
> You can take her to the doctor, you can try getting her to move her
> bowels during the day or before bed, but you KNOW this is a "normal"
[quoted text clipped - 12 lines]
> 6d - Urinary incontinence
> 6e - Fecal incontinence
Evelyn Ruut - 25 Mar 2007 03:55 GMT
Alan,

The alzheimer association is just made up of people like you are talking to
right here.   I know just from reading here for a couple of years, that it
isn't a bit uncommon, in fact it is common enough that it just could be part
of the deterioration of the brain that happens in this particular illness.

Also, not every person has the same symptoms you know, and not every person
gets this particular one.   My mother in law did not experience it, though
she did have urinary incontinence for several years.

The best bet would be to talk to her doctor, but again, I would draw the
line if any fancy testing was suggested, for reasons I already mentioned.

Signature

Best Regards,

Evelyn

>I called the Alzheimer's Association and they said it wasn't
> necessarily related to Alzheimers and that it wasn't a given that this
[quoted text clipped - 19 lines]
>> 6d - Urinary incontinence
>> 6e - Fecal incontinence
Mary_Gordon@tvo.org - 25 Mar 2007 15:15 GMT
Here are the stages of Alzheimers. Not everyone's course follows the
description exactly (i.e. some people seem to straddle various stages,
having characteristics of more than one, and holding on to some
abilities longer than others). I've been answering Alzheimer's
questions for allexperts for many years, and everyone who survives
long enough to get into the later stages becomes incontintinent. its
just reality. They lose their ability to recognize what the sensation
of having to "go" means, as well as any understanding of what a toilet
is for and how to use it.

In 1982 Dr. Barry Reisberg published what was to become the best and
most widely accepted
description of the stages of Alzheimer's disease. Even today, years
later, when experts referto a person being in stage 5 or stage 6, they
are referring to Dr. Reisberg's scale of seven stages.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The
global deterioration scale for the assessment of primary degenerative
dementia. American Journal of Psychiatry, 1982

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints of
memory deficit. No memory deficit evident on clinical interviews.

Level 2
Very mild cognitive decline (forgetfulness or normal older adult).
Subjective complaints of memory deficit, most frequently in the
following area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well.
No objective evidence of memory deficit on clinical interview. No
objective deficits in employment or social situations. Appropriate
concern regarding symptoms.

Level 3
Mild cognitive decline (early confusional or Early AD). Earliest clear-
cut deficits. Manifestations in more than one of the following areas:
(a) patient may have gotten lost when traveling to an unfamiliar
location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little
material;
(e) patient may demonstrate decreased facility in remembering names
upon introduction to new people;
(f) patient may have lost or misplaced an object of value;
(g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only with an intensive
interview. Denial begins to become manifest in patient. Mild to
moderate anxiety accompanies symptoms.Deficits noticed in demanding
employment situations.

Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut
deficit on careful clinical interview. Deficit manifest in following
areas:
(a) decreased knowledge of current and recent events;
(b) may exhibit some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions;
(d) decreased ability to travel, handle finances, etc.

Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations.
Inability to perform complex tasks. Denial is dominant defense
mechanism. Flattening of affect and withdrawal from challenging
situations occur.

Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD).
Patient can no longer survive without some assistance. Patient is
unable during interview to recall a major relevant aspect of their
current lives, e.g., an address or telephone number of many years, the
names of close family members (such as grandchildren), the name of the
high school or college from which they graduated. Frequently some
disorientation to time (date, day of week, season, etc.) or to place.
An educated person may have difficulty counting back from 40 by 4s or
from 20 by 2s. Persons at this stage retain knowledge of many major
facts regarding themselves and others. They invariably know their own
names and generally know their spouse's and children's names. They
require no assistance with toileting and eating, but may have some
difficulty choosing the proper clothing to wear.

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD).
May occasionally forget the name of the spouse upon whom they are
entirely dependent for survival. Will be largely unaware of all recent
events and experiences in their lives. Retain some knowledge of their
past lives but this is very sketchy. Generally unaware of their
surroundings, the year, the season, etc. May have difficulty counting
from 10, both backward and sometimes forward. Will require some
assistance with activities of daily living, e.g., may become
incontinent, will require travel assistance but occasionally will
display ability to orient in familiar locations. Diurnal rhythm
frequently disturbed. Almost always recall
their own name. Frequently continue to be able to distinguish familiar
from unfamiliar persons in their environment. Personality and
emotional changes occur. These are quite variable and include
(a) delusional behavior, e.g., patients may accuse their spouse of
being an impostor, may talk to imaginary figures in the environment,
or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may continually repeat simple
cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent
violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual
cannot carry a thought long enough to determine a purposeful course of
action.

6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal
abilities are lost. Frequently there is no speech at all - only
grunting. Incontinent of urine, requires assistance toileting and
feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting
and head control.The brain appears to no longer be able to tell the
body what to do. Generalized and cortical neurologic signs and
symptoms are frequently present.

7a - Speech ability limited to about a half-dozen intelligible words
7b - Intelligible vocabulary limited to a single word
7c - Ambulatory ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost
Mary_Gordon@tvo.org - 25 Mar 2007 15:22 GMT
Here is a good no-nonsense set of advice for caregivers facing urinary
or fecal incontinence from a caregiver who has obviously been there.

M
Mary_Gordon@tvo.org - 25 Mar 2007 16:16 GMT
Whoops, forgot the URL
http://www.bigtreemurphy.com/Incont.Home.htm
Tumbleweed - 25 Mar 2007 19:15 GMT
>I called the Alzheimer's Association and they said it wasn't
> necessarily related to Alzheimers and that it wasn't a given that this
> goes with it. Even urinary incontinence they said wasn't necessarily
> part of Alzheimers. I will do some further reading on it. Would you
> have the link to your source? Thanks!

Well, its not *necessarily* related, in the sense that someone with Az
*might* also have another condition that causes memory loss as well, but by
far the likeliest cause is the natural progession of the condition as per
MG's post. AFAIK the only reason it wouldnt eventually be part of Az is that
you might die before you reach that stage. Sounds to me like the person you
spoke to really wasnt very well informed. Have you been to a home with Az
patients and taken a deep sniff?

In the home my father is in, I would guess 50% are at some stage of
incontinence, and my dad is headed in that direction.

Signature

Tumbleweed

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com

Mary_Gordon@tvo.org - 25 Mar 2007 20:27 GMT
I can't see how anyone could survive to the last stages and NOT be
incontinent, since more and more as things progress....they stop being
able to interpret body signals correctly (they may feel something but
not know what it means, much less what to do about it).

They lose the ability to do things in sequence....so in order, they
need to sense they need to go and what that feeling means, know you
need a bathroom, know where it is and go in there, take your pants
down, sit on the throne, do your thing, clean up, pull your pants back
up, flush, wash hands etc. Very complex series of actions that will be
beyond most by mid to later AD. They might have success with prompting
and supervision, but that supposes the caregiver is always with them,
can always read the signs of needing to go, and can hustle them into
the WC before the inevitable occurs.

I mean....as we moved through stage 6, my mother in law could no
longer dress herself, feed herself, wash herself. She stopped speaking
intelligibly, she lost her ability to walk. How the heck would anyone
think she would be anything OTHER than totally incontinent. She lived
two full years in the final stages, she wasn't fortunate enough to be
carried off by some other illness (such as Evelyn's MIL, whose days
were ended by cancer). She could no more have told you she needed to
use the bathroom than driven to the 711. We found she didn't respond
to hunger, thirst or pain the way a "normal" person would - so
expecting her to feel and understand what the sensations of a full
bladder or bowel were...can't imagine that.

If you die from AD, you die incontinent, and that reality will set in
some time before the AD shuts you down to the point you spiral towards
the end. The people at the AD society may have been thinking of
someone in earlier stages. It is always worth seeing a doctor to rule
out medical issues, but don't expect a whole lot in terms of a fix.
Its a function of brain damage.

M.,
Evelyn Ruut - 26 Mar 2007 00:19 GMT
Alan,

Mary and Tumbleweed have been very accurate in what they have told you.
Just wanted to say that.

Ask in any nursing home, or amongst actual caregivers.   You might have
gotten some secretary at the alzheimer association who may not even know,
from real life.

It is a horrible and unpleasant truth, but the end of life is seldom easy
and simple or neat.   Only the very fortunate die suddenly without some very
unpleasant experiences beforehand.

You do what you have to, and do the best you can.

Signature

Best Regards,

Evelyn

deerwoodflower@hotmail.com - 27 Mar 2007 06:53 GMT
On Mar 24, 9:27 am, "alanry...@aol.com" <alanry...@aol.com> wrote:
> My mother has had some episodes of this at night lately. Her stools
> seem to be a bit loose. She has urinary incontinence all the time, but
[quoted text clipped - 6 lines]
> suggestions of what I might try? Would this be a gastroenterologist if
> I wanted to have her checked? Any medication to help? Thanks!

Is it normal for her stools to be loose?My mom has maybe 3 episodes of
waking up poopy.I am thinking she is in stage 6.But it is not on a
regular basis. If it's not normal then try some immodium.Usually once
will take care of it.Barb
 
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