Fecal incontinence; any experience or recommendations?

Unfortunately, I have quite a bit of experience dealing with fecal incontinence caring for someone. I think it's time to stop using real underwear. She needs to use disposables. I don't see why your doc thinks that pull ups would spread poop. Just because you pull them up, doesn't mean you have to pull them down. They are built to tear at the waist so can be removed just like the tabbed ones. I only use tabbed ones since it's so much easier to get on. You don't have to take pants or shoes off. Much easier to do especially when not at home.

I don't know of any diapers that are designed for poop. I've often wished there was one with a little pouch for poop. Two things are key in my experience. Consistency of the poop and room to hold it. Don't put on diapers that are too small or too tight. I pick diapers and put them on so that there is room. Done right, there should be any leaking by leaving it a little loose. You still want the seals along the leg to be snug, but the bottom section to be roomy.

Consistency is key. I've found that I can make it go anywhere from liquid to rock hard by varying diet. There are pros and cons to all consistencies. Liquid is bad that it comes out constantly, it's good in that the diaper just soaks up most of it. Rock hard is good in that it only happens occasionally, it's bad in that it's so firm that it can deform and then it can't come all the way out. This is not a problem when the person con control when the go, but with incontinence it just happens whenever.

I found that the middle ground works best. Not too firm, not too soft. Pretty much like frozen yogurt. Firm enough that it's not leaking out constantly. Soft enough that it will deform and allow for passage into a roomy diaper. It makes every diaper change a poop change, but I find that better than having a dramatic hours long hard poop event.

Make sure you use plenty of A&D cream. Not to prevent diaper rash, that's just a great fringe benefit. But having a layer there makes the cleanup so much easier.

I agree with almost everything needtowashhair said except that runny poop soaks in, in my experience it just overflowed long before there was any absorption🤔.

That MD has probably never had any real life experience cleaning up after fecal incontinence - even if the pullup doesn't hold everything it's got to be better than pads, and does s/he think poop filled underwear are somehow easier to deal with?

One suggestion is to try to figure out when your mom tends to go and get her to the toilet before that, most people are surprisingly regular and tend to go shortly after eating. Even if this only works occasionally I always figured that one less clean up was worth it.

I see now that I wasn't totally clear on the type of fecal incontinence my mom has. She has the runny-throughout-the-day kind. Very liquidy. Her bowel movements are usually normal, though she is having increasing bouts of diarrhea. She's also still rather independent and, well, vain. She was always a beautiful woman, she still doesn't look 85yo and hates the idea of wearing diapers. We have "strong discussions" about the Tena pads as it is. I also should explain that her MD has dealt with dementia and ALZ with both her grandmother and mother so he actually does have personal experience. I mentioned her thoughts on it based on a discussion with her 6 months ago. She may well have a different opinion now. Oh and to add to the issue, My mom had a colonoscopy a couple of weeks ago and it was discovered that she has a massive polyp just inside the entrance to her rectum which will need addressed....

Switch to the disposable incontinence briefs. There are some pretty ones that she might not even realize are "different"
No pads unless it is really necessary but for the most part the briefs should absorb all the liquid.
Bathroom time should be set so that there is a "schedule" and maybe you can get some of the loose watery stool before is leaks if that is a problem.
How long has she has the watery stool and leakage? It might be a direct cause of the colonoscopy that was done.

OK that makes a difference. I can see that very small amounts of fecal matter would be easier to deal with using pads, but it seems as though she either isn't changing often enough or this is much more than spotting. Either way the pads aren't doing the job so I would make the switch to the lightest weight pull ups, in my experience if her underwear are soiled to the extent you see then her outer clothes - and probably the furniture - is as well.

It seems odd to me that she would be having normal BMs and still experiencing runny leakage, is the doctor giving you any thoughts on why? Does she feel the polyp is to blame?

As far as I remember, most of the major manufacturers make disposables for fecal incontinence. Certainly Tena do - this isn't a specific recommendation, only I'm fairly sure they'll be available in the USA and I'm not so sure about other brands.

I went back to the e-tailer I found best for ordering from to see what they said, and found this article. Bearing in mind that their profit comes from selling products I'm impressed!

Oh drat - it's too long, I'll have to post it in two parts (three parts, sigh)

Faecal Incontinence
 
What is Faecal Incontinence?

Faecal (or Fecal) incontinence is an inability to control bowel movements, resulting in the involuntary passage of stools. It is also sometimes known as bowel incontinence.
The experience of faecal incontinence can vary from person to person. Some people feel a sudden, urgent need to go to the toilet, and incontinence occurs because they are unable to reach a toilet in time (similar to urge urinary incontinence). This is known as urge faecal incontinence.
Others may experience no sensation at all before passing a stool, this is known as passive incontinence or passive soiling. Alternatively they may pass a small piece of stool while passing wind. Some people experience faecal incontinence on a daily basis, whereas for others problems only occur from time to time.
 
How common is Faecal Incontinence?
Faecal incontinence (sometimes spelt as Fecal Incontinence) is more common than many realise. It is thought around 10% of people will be affected by it during their lives. It can affect people of any age, though the problem is more common in elderly people. Recent studied from the UK primary care database showed the condition was more common for women. People with the highest likelihood of developing faecal incontinence are patients with anal problems (such as women with third or fourth-degree obstetric injury, people with rectal or pelvic organ prolapse, those undergoing pelvic radiotherapy or colonic resection and patients with perianal itching, soreness or pain or anal surgery), people who experience with urinary incontinence, the frail or elderly, people with dementia, neurological problems or spinal disease (eg, CVE, MS, spina bifida or spinal injury) and those with severe cognitive impairment or learning difficulties.
 
What Causes Faecal Incontinence?
Faecal incontinence is not a condition in itself. It is a symptom of an underlying problem and conditions making it important to seek medical assessment to treat the underlying cause.
There are potential causes, some more common than others, usually triggered by a physical issue with parts of the body controlling passage of stools.
The most common cause is damage to one or both of the anal sphincter muscles. The external anal sphincter is responsible for delaying bowel emptying once the rectum fills and the urge to empty the bowel is felt. People with a weak or damaged external anal sphincter muscle typically experience urgency and may pass stools before they are able to reach a toilet. People with a damaged internal anal sphincter usually experience 'passive soiling', where soft or small pellets of stool leak out without realisation.
Constipation is a leading cause of bowel incontinence. In cases of severe constipation, a large, solid stool can become stuck in the rectum, known as faecal impaction. This begins to stretch and weaken rectum muscles. Watery stools can leak around the stool bottom, causing faecal incontinence.
Diarrhoea can be a cause as well as symptom. Diarrhoea can be chronic, i.e. on-going and reoccurring, or acute, i.e. sudden and unexpected.
Conditions that can cause recurring diarrhoea include Crohn's disease (causing inflammation of the digestive system), Irritable Bowel Syndrome (widely referred to as IBS, causing a range of digestive symptoms, including diarrhoea and bloating) and Ulcerative Colitis (a condition causing inflammation of the large bowel). [cont'd above]

All these conditions can cause scarring of the rectum, which can lead to faecal incontinence.
Faecal incontinence is also caused by problems with the nerves connecting the brain and the rectum. A nerve problem can mean your body is unaware of stools in your rectum, and may make it difficult to control your sphincter muscles. Nerve damage can be related to a wide number of conditions, including diabetes, multiple sclerosis, stroke, spina bifida and spinal cord injury.
People with disorders like Parkinson's and Alzheimer's/Dementia can sometimes develop faecal incontinence associated with their illness. Some may develop incontinence following gynaecological, prostate or rectal surgery, as can chronic laxative abuse in the long term.
Some medications like antibiotics can cause loose stools / diarrhoea, worsening symptoms.
 
Diagnosing Faecal Incontinence
Faecal incontinence is a symptom, and there are often multiple contributory factors. Health professionals shouldn't concentrate on one diagnosis to the exclusion of other factors.
Before you see your health professional, keep a bowel diary for a week or so before your appointment to record trips to the toilet, any accidents you have and what you eat or drink. This will be useful for the Doctor, potentially highlighting underlying causes of your symptoms.
The starting point of diagnosis is baseline assessment including medical history, general examination, anorectal examination and assessment of cognitive function (if appropriate), identifying contributory factors before treatment is considered.
People with the following conditions should have these addressed with condition-specific interventions before healthcare professionals progress to initial management of faecal incontinence: faecal loading, causes of diarrhoea (for instance, infective, inflammatory bowel disease and irritable bowel syndrome), warning signs for lower gastrointestinal cancer, rectal prolapse or third-degree haemorrhoids, acute anal sphincter injury (including obstetric and other trauma) and acute disc prolapse/cauda equina syndrome.
Further tests that may be carried out include:
Endoscopy - Internal examination of the rectum (and sometimes lower bowel) using a long, thin flexible tube with light and video camera attached. Images taken of the inside of your body are sent to an external monitor. This checks for obstruction, damage or inflammation in your rectum.
Anal manometry - a device similar to a small thermometer with a balloon attached assesses how well the muscles and nerves in the rectum are working, and the level of sensation within those nerves.
Ultrasound - Creates a detailed picture of the inside of your anus. Particularly useful in detecting underlying damage to the sphincter muscles
Defecography - a test using liquid barium to study exactly how you are passing stools. Also useful in detecting signs of obstruction or prolapse not discovered from rectal examination.
 
How can I manage Faecal Incontinence?
With the right treatment many individuals can maintain normal bowel function throughout their life. Treatment often depends on the cause and severity of the condition, with a number of possible options.
Lifestyle and dietary changes can help relieve constipation or diarrhoea. It's important that nutrient intake remains balanced, and is advisable to modify only one food at a time. Those with hard stools or dehydration are encouraged to intake at least 1.5 litres of fluid per day (unless otherwise advised). Other advice includes limit fibre intake from wholegrain breads, bran, cereals, nuts and seeds (except golden linseeds), avoiding skin, pips and pith from fruit and vegetables, limiting fresh and dried fruit to three portions a day and fruit juice to one small glass a day (the remaining five a day can be achieved with vegetables), avoiding fizzy drinks, caffeine and high-fat foods, such as chips, takeaway and burgers.

[cont'd again!]

Part 3

A high-fibre diet is often recommended for constipation-associated incontinence, however it's important to discuss this with your Health professional who can confirm this course of action. Fibre can soften stools, making them easier to pass. High-fibre foods include fruit, vegetables, beans, wholegrain rice, wholewheat pasta, wholemeal bread, seeds, nuts and oats. Drinking plenty of fluids can also help with softening and passing stools.
Other causes of faecal incontinence may require more intensive interventions. If caused by weakness in the pelvic floor muscles then Pelvic floor muscle training is usually advised. The aim being to strengthen any stretched and weakened muscles. A therapist, usually a physiotherapist or specialist nurse, will teach you appropriate exercises. Ideally these should be carried out three times daily, for six to eight weeks, After this an improvement in your symptoms should be noticeable.
Bowel retraining assists those with reduced rectum sensation resulting from nerve damage, or those with recurring episodes of constipation. The three main goals of bowel retraining are improving stool consistency, establishing regular times to empty the bowels and finding ways of stimulating the bowels to empty themselves. Methods of stimulation differ from person to person. Some find a hot drink and meal can help, others may stimulate their anus using their finger.
Other treatments to consider include:
Biofeedback - A bowel retraining exercise, placing a small electric probe into your bottom.
Medication – Used to treat soft or loose stools or constipation associated with bowel incontinence. Common medications include Loperamide, treating diarrhoea by slowing down stool movement through the digestive system, allowing more water to be absorbed . Laxatives can treat constipation, helping passage of stools. Bulk-forming laxatives are usually recommended. These help stools to retain fluid, becoming less likely to dry out and cause faecal impaction.
Enemas or rectal irrigation – Used in cases where bowel incontinence is caused by faecal impaction and other treatments have failed to remove the impacted stool. A small tube is placed into the anus, while a special solution is used to wash out the rectum.
Surgery – Only recommended for treatment after other options are attempted. Typical surgical treatments use sphincteroplasty (to repair damaged sphincter muscles) and sacral nerve stimulation (Electrodes stimulating the sacral nerves, helping the sphincter and pelvic floor muscles to work more effectively). Other treatments such as tibial nerve stimulation, endoscopic heat therapy and artificial sphincter surgery are less widely used.
Incontinence products including disposable pads, pants and anal plugs may be recommended for use until symptoms controllable.
No matter what type of Incontinence you or the person you care for is experiencing it is important to discuss with a Health Professional. Incontinence is often a symptom of an underlying condition, which simple steps can often improve.

*** end of article ***

I had bouts of microscopic inflammatory colitis which is constant loose stools. My doctor said I could try a drug called Colestid. If you look it up, I’ve read forums where people swear by it. I didn’t have to take it as the colitis went away but would try if I had what your mother does. Ask her GI doctor about when you talk to her/him. It can give her back quality of life.

My MIL has IBS. We use disposable underwear. I don't see how feces will spread any more than using pads. It will be important to clean her and change the underpants after an incident. There are pull up versions as well as ones designed more like baby diapers. We have recently started her on Align probiotics and boosted her fiber at breakfast and that has reduced the frequency of what we refer to as fecal emergencies.

Kirahfaye, I see that the drug colestid she was prescribed now has a generic version Colestipol which may be more affordable. You could check her insurance formulary to see. Also try GoodRX.
As far as products go, Moms NH used the types of briefs with tabs so that shoes and pants didn’t have to be completely removed. When the emergencies happen, speed is important.

A visit to the neurologist yesterday showed that my husband's dementia, fecal incontinence and shuffling gait are all signs of hypocephalus - an enlargement of the ventricles in the brain due to too much fluid. Spinal tap and maybe a shunt implanted in the brain to redirect fluid could put him back in good shape, I'm reading. DEFINITELY worth looking into for your mum. My husband has been in decline for a couple three years (he's a 77 yr old now-ex triathlete) but it wasn't until the fecal incontinence started happening regularly that I brought it up to the dr. who pulled up his last MRI and saw just that - enlarged ventricles. We are due for a new series of tests, but there is the possibility he could be again be more like his old self. #keepingfingerscrossed #GREATdoctor.

Loperimide is a anti diarrhea medication as is immodium. My husband who does not have any dementia but had rectal cancer, uses these medication before meals and when leaving the house. There is a cholesterol lowering product called Olestyr /Cholestyramine that firms up bowel movements (as a side effect) . He also uses Metamucil to stop runny feces, it seems to bind the poop.
As for pads and liners. He has found a long panty liner helps for when he involuntarily passes gas and leaks ( he tries never to do that but some escape if he bends over or ties shoes, gets out of car etc. ) you are right that fecal pads are not common and he hates pullups

Discuss with the doctor bowel issues, Does mom have diarrhea? Something must be causing it: food intolerances, infection, too much fiber...? Does mom not realize when she needs to go? Maybe she has a rectocele and needs a vaginal pessary. Adult diapers would be the easiest solution. Get pull-ups will tear away sides. There are some really pretty ones out there now days. Carry baby wipes.

My SIL wore pull-ups and she had fecal incontinence. I don't know what brand. She passed last year so I cannot ask. I would suggest you either ask your Family Physician or his/her nurse to recommend brands. Depends will send you samples.

RE: the mess: For my DH, he used wash-cloths to clean himself and they also got rather nasty. I googled and found that you can make a "diaper pail" using dishwasher detergent for the soaking element and it worked great! Better than bleach!! The dishwasher detergents are designed to break-down food, and fecal matter is really just processed food.

I kept the bucket in my kitchen, on the counter, and there was absolutely no smell! I had a supply of the cheaper cascade pods and I dissolved one in hot water and it took care of the bucket I was using. It was similar in size to a 1-gallon ice cream bucket and held about a weeks worth of cloths. I had a long-handled spoon that I used to stir it up whenever I added wash-cloths.

I did this for about a year, until DH passed away.

Hi.... I TRULY understand what you're dealing with as I, too, have had fecal incontinence for the last 2-3 years (though I've had chronic diarrhea since 2004 due to a rare form of colitis). I am only 63 and I don't suffer from ANY form of dementia (yet, as my mom is currently in the moderate, trending to more severe Alzheimer's).

That having been said, I've been wearing the Depends, or the store brand (CVS) pull up "panties" in the HEAVY coverage. Mine CAN BE quite explosive, too, but it's actually rare when it's not been able to control what "comes out" and at least gives me "some" time to get to the bathroom to change them.

I HOPE that I've helped, if just a little bit, since they've been working for me. Oh, also, you can buy them in bulk (60, I believe) and at a MUCH lower overall cost via Amazon!

My husband is in stage 5 Parkinson's. They generally have constipation, but he has fecal incontinence. We've gone to several different types of doctors and there hasn't seemed to be a good answer (for him). We have changed diets, now eating minimal just about everything (that previously we were taught to eat more of...) The best we have come up with is - I give him a half of an imodium each morning about a half hour before breakfast. It will at least 'firm it up' and give him half a chance to make it to the bathroom. With just half a tablet, it does not give him constipation.

You might try a probiotic supplement like CoreBiotics, if she will swallow pills. Also
apple cider vinegar once a day instead, although it doesn't taste great. It's worth a little trouble getting her to swallow if it helps you do less work on the other end. Neither should hurt anything and might help. A lot. Good luck to you.

She needs to wear a heavy protective feminine product. How can she stand sitting in poop-filled underpants? Or doesn't she realize that? I, myself, wear protective feminine pads because you don't want to be embarrassed. Good grief!

My husband has dementia and has both u/f incontinence. I have not found a good product or tricks to reduce the frequency of the mess. The only method that seems to work for him is taking him to the bathroom every three hours for 30-45 mins. Not the best solution but it helps.

Worked for me plain Kefir I make my own 2 6oz glasses or so a day.

If your parent’s stools are
normal (they’re not liquid or too frequent )then you might suggest an adult pad that she can slip into her panties and easily dispose of. Also Kroger’s and Walmart carry adult wipes they are actually called washcloths; they are large, moist and soothing, Keep them conveniently placed in the bathroom and hopefully your mom will acquire the habit of using disposable washcloths rather than toilet paper.
If your mother’s stool occurs Unusually frequently, or are Pale or too dark, or loose, you might want to check the side effects of her medication or her diet especially if she is a diabetic and discuss or have her discuss this with her physician. Good luck.

So sorry to see your predicament. . . does your Mom have a neurologist? My husband had these issues PLUS dementia signs which signaled to our neurologist he might have hydrocephalus. which he does! It's a long explanation, so forgive me if I ask you to google it and talk to your doctors. It is quite often overlooked apparently but it could be life changing to diagnosis properly and take care.