I started writing this blog post two years ago and then abandoned it because I felt it was just too much even for me. Talking about adults wetting themselves is a tricksy old business and there was a part of me tied up in knots with embarrassment for my mum at the thought of people reading about it. But now I look back at these feelings almost fondly because that ship has long sailed. Mum is happily in her incontinence pants 24/7 and I am starting to forget a time when she wasn’t so it seems an opportune moment to let this particular story go out into the world like a glorious flock of doves (doves who then crap all over your car). ‘Go fly, my Pretties!’……
Incontinence – da da daaaaaah!
Can we talk about this? Yes we can! I have to be honest, I was very torn about whether to tackle this issue because to many it will seem terribly indelicate and personal but that is one of the massive advantages to having an anonymous blog. Whilst I was toying with the idea of whether to write about it or not I asked myself whether I would have found it helpful to read a first hand account of someone else’s experience in dealing with incontinence in dementia and I thought Bloody Hell – Yes! In fact, for a few days last week that was ALL I wanted to read about. And could I? NO. Is there any ‘warts and all’ information out there? NO. Are there practical tips about where to get incontinence pads from, how to protect your sofa and bedding without drawing too much attention to it and how to make sure someone you love is clean and dry without losing the will to live? NO!!! So I’m going to man up and write about it, because if in a year’s time just one person stumbles across this blog in their hour of need it will be worth airing our dirty laundry in public (more literally than I had initially anticipated).
Before I launch into the full story I must point out that the person who was really at the sharp end last week was my sister who captured the situation perfectly when she sent me a photo of the mountain of washing generated by having mum come to stay for less than 24 hours. It was my brother-in-law who did the Tena-lady dash to the supermarket and my dad who has dealt with the fall-out since. I have had little to do with the practical stuff on this occasion.
I also ought to point out that this recent episode was caused by a urine infection and seems to have been resolved with a short course of Trimethoprim but I suspect if nothing else it is a glimpse of things to come and it has been quite a shock to all concerned. I have been a GP for 12 years now and as a result I am perfectly happy talking about wees and poos and bums (and willies, discharge and snot for that matter). It’s also not that long ago that I was potty training my children so dealing with soiled undergarments and bed linen is relatively familiar. However, adult incontinence, as I have touched on before, is a clear ‘no go’ area in terms of generally acceptable conversation. Dad had studiously avoided all of our toilet-related questioning but if really put on the spot he maintained that there had been no problem other than occasional failure to flush.
However, on returning from a recent holiday with friends it was apparent that things had changed. He called both me and my sister on the day they flew back and was more downbeat than I had ever heard him. Clearly things hadn’t gone well and it seemed that instead of a relaxing holiday he had basically had a week of the usual caring duties but in a much more stressful environment. I pushed on and asked about specifics – ‘Had there been any particular incidents? Had she wandered off? Caused a scene? Sustained an injury?’ No. But ‘there were a few accidents’ he said ominously. Oh.
It turns out that a couple of these accidents (i.e. episodes of incontinence) occurred in the hotel loo and seemed to be a simple case of not getting there in time but he described one incident which on its own encapsulates the very worst thing that dementia has done to my mother. In an expensive restaurant, out with friends, surrounded by other diners dressed in their finery she started coughing (see You’ve got to be choking ), vomitted over the table and wet herself. There. That’s it. You may never understand how painful it was to write that last sentence but if my mother had had any idea that she would ever be in this scenario she would have thrown herself under a bus years ago. She would have been appalled to have even been in the same dining room witnessing such a messy fiasco – listening to dad relate this story with weary resignation was ghastly. I know that I would have been mortified to have even been there and I feel quite guilty about that, but my dad was there watching it happen to his wife. This is a man who. despite having two daughters, used to have to leave the room if a tampon advert came on the TV. Bodily functions, specifically regarding the nether regions are known to occur but never referred to.
Anyway – you get the idea that this was kind of a big deal and for dad to be talking about it meant that we had a small window of opportunity to look at long term personal care needs (I genuinely love the phrase ‘personal care’ – it tells you all you need to know but in a nice friendly way). The accidents seemed to have stopped since they had returned home so we assumed that they had occurred on holiday as a result of disorientation, being in unfamiliar surroundings. This had implications for future holidays but we thought we had time to get ourselves organised. My sister offered to have mum come to stay for a night just to give dad a bit of respite and we started looking into options to increase the care package (2 hours of the lovely Alison was unlikely to cut the mustard for much longer).
While mum was staying at my sister’s it seemed that the urine infection started to really kick in – whether the incontinence on holiday had been due to an emerging infection or just disorientation we will never know but suffice to say that the overnight stay was not a success. Mum wet herself on pretty much every piece of upholstery in my sister’s house and barely an hour went by without some incident or other. My sister called to alert me about five hours after mum had arrived on the Saturday – she didn’t want to tell dad and interrupt his few moments of solitude so she struggled on through the evening and night with towels on sofas and mattress protectors on the bed (inevitably mum wet the bed on the side with the mattress protector then rolled over to try and avoid the damp patch and wet herself on the unprotected side too). By the time dad came to collect her on Sunday my sister had washed every stitch of clothing that mum had packed as well as many sheets and towels and the duvet was in a heap awaiting the laundrette. We had a series of emergency phone calls and it became apparent that there was likely to be a cause for such a dramatic turn of events so I suggested that dad get a urine sample from mum (he didn’t look thrilled at the prospect bless him). He saw the practice nurse on Monday, handed in the sample and lo a urinary tract infection was confurmed.
Since then the antibiotics have kicked in and the situation has improved radically. Dad has reported only one accident on the floor of the bathroom in the past week which I have told him to mention to the GP (who he is seeing today as it happens) because nobody really knows how much of this improvement is due to the resolution of infection and how much is down to being on home turf. I guess we’ll find out in a few weeks time when mum comes to stay with me for a long weekend! In the meantime I have a few key messages / take home points / whatever corporate jargon you prefer:
- Assume that at some point incontinence is going to be an issue you need to address if you have a relative with dementia. Be prepared for this emotionally as well as practically (see point 4)
- A supply of Dri-nites bed mats and incontinence pads is never going to be a bad thing to have in the house. If you can’t find or can’t bear the thought of Tena pads then maternity sanitary towels or similar will do for emergencies (any port in a urinary storm). They are also very absorbent and useful for any manner of scenarios although people may look slightly askance if they see you mopping up their spilt tea with one.
- Sudden incontinence, very smelly wee or a sudden worsening of confusion is often a result of an infection. Urinary infections are more common in the elderly and those with dementia and they do not present in the same way as they do in healthy adults (i.e. the person may not complain of pain or increased frequency) so you need to be on your guard and have a specimen pot in the house.
- Try as hard as you can not to be appalled / repulsed by the incontinence, or at least try not to show it, However advanced the dementia there seems to be a very primal response from those who have been incontinent, they know they have done something ‘wrong’ and this in itself is very distressing. Keep reminding yourself that one day this could be you….. And then go and jump off a bridge (no, not really).
Please to also have a look at this from the Alzheimer’s Society where the whole issue is handled much more sensitively and kindly. Leaflet – Personal Care