Incontinence

Incontinence is lack of control of the bowels or bladder.

What you need to know

• For some people, the best choice for controlling regular ongoing incontinence of urine is use of a catheter.
• A catheter is a tube put in the bladder so the urine can drain into a specially designed bag.

How you can offer comfort and care

• Skin breakdown, which can be caused by pressure and contact with urine or a bowel movement, is a risk from incontinence. Clean and dry skin is very important in preventing this skin breakdown.
• Consider special incontinence garments (e.g. Stayfree^™, DryPlus^™, Attends^™, Poise^™, Ensure Guards^™) which are available at drugstores and supermarkets. They keep the bed dry and should be changed often. Your home care nurse can give you advice about these. You may be able to get financial assistance to cover their cost (see Appendix I Financial Aid, page 146).
• Use water-repellent creams containing zinc oxide and silicone (e.g. Zincofax^™, Penaten Cream^™, A&D Cream^™) applied as needed t​o help prevent skin irritation. A silicone and zinc oxide spray (e.g. Silon^™) may be available and may be easier to use.
  
• When the person has a permanent catheter, wash the area where the catheter enters the body at least once a day with soap and water to protect the skin and prevent infection.
  
• Wash your hands before and after touching the catheter, drainage bag or incontinence garments.
• Check the drainage tubing for kinks and make sure the drainage bag is below the level of the person to encourage draining by gravity.
• Empty the drainage bag at least twice a day.

Constipation

When a person has a bowel movement, stool (feces) is passed. Constipation means infrequency or difficulty passing stool. Due to the progressive illness constipation can happen because of:

• medications such as opioids.
• less drinking.
• less eating.
• low fibre in diet.
• less physical activity.
• the type of progressive illness.

Constipation must be assessed and verified by your home care nurse and doctor to make sure there is not an obstruction that may also be interfering with the passing of stool.

What you need to know

• Stool is still produced even when the person is not eating.
• Constipation is uncomfortable and may cause serious problems. Keeping ahead of it through prevention is very important.
• Stool may be dry and painful to pass.
• The person may have large amounts of gas, burping, or feel sick to the stomach.
• There may be pain in the abdomen.
• What may appear to be diarrhea may in fact be small amounts of runny stool escaping around the hard constipated stool.
• The person may have small hard bowel movements, but not enough stool to correct the constipation.
• Headaches and possibly confusion may accompany constipation.
• The person’s abdomen may look blown-up or bloated.
• The doctor may prescribe a stimulant and or laxative medication that can come in the form of a pill, liquid or a suppository (see Giving Medications by Suppository, page 64).
• Some people with constipation are not able to take or do not respond to medications or diet changes and may need an enema.

How you can offer comfort and care

If you are aware of the causes, you may be able to take steps to prevent constipation. Keeping the stage of the advanced illness in mind, consider whether the following strategies might be tolerated:

• Try gradually increasing the intake of fiber and whole grains in cereals and breads. At the same time, a large amount of fluid must be taken in to move the fibre through the system.
• Increase fluid intake.
• Offer a hot drink with caffeine in the morning to encourage a bowel movement.
• Encourage the person to walk, exercise or move about in bed.
• Avoid foods that can cause constipation such as chocolate, cheese and eggs.
• Remind the person of the need to take prescribed laxatives especially if opioids are being used (see Possible Side Effects or Complications of Opioids, page 75).
• Offer a variety of fruits (including prunes), vegetables and fruit juices (including prune juice) once a day. The following fruit laxative may be a way to encourage the person to take a variety of these helpful foods.

Fruit laxative (use dried fruit)

• 1/4 cup currants
• 1/4 cup dates
• 1/4 cup raisins
• 1/4 cup figs
• 1/4 cup prunes
• prune juice

Bowel routine

Anyone using regular opioids for pain should also use a laxative. A daily basic bowel routine is also advised for someone using opioids. The following is one suggested routine:

• Bowel stimulants and laxatives (e.g. Senokot^™ or Lactulose) can be taken once or twice a day.
• Laxatives stimulate increased bowel activity and help to create a bowel movement.
• They can be purchased at the drugstore and their cost may be covered by a drug program (see Appendix I Financial Aid, page 146).

Enemas

An enema is fluid injected into the rectum to clean out the bowel. To give a small enema such as a Fleet^™, the same procedure is followed as for suppositories.

• Help the person into a position that will make it easy to insert the enema tube. The best position is lying on the left side, with the upper leg bent forward. (There should be a diagram on the instructions that come with the enema.)
• Advise the person that the enema may cause a feeling of pressure and cramps. Encourage them to take deep breaths and hold the enema in as long as possible before expelling.
• The tube will already be lubricated.
• Insert the tube gently into the rectum and squeeze the container.
• Go slowly but try not to stop if the person has discomfort. Use the full enema or as much as the person can tolerate.

Diarrhea

Diarrhea is the passage of loose or watery bowel movements three or more times a day. There may or may not be discomfort. Causes of diarrhea include infections, some medications, surgery, fistulas, laxatives, side effects of chemotherapy, radiation therapy to the abdomen, and sometimes the disease itself.

What you need to know

• Diarrhea can upset the body’s balance of salts and chemicals called electrolytes.
• Certain foods can make diarrhea worse while other foods may help slow it.
• Dehydration is always a risk from severe diarrhea.
• Diarrhea can also be the overflow of liquid stool around hard stool. In this case, it should be treated as constipation (see Constipation, page 87). Ask your home care nurse about this possibility.

How you can offer comfort and care

If possible, food and fluid should be the choice for restoring the fluid balance of the body.

• Choose foods high in protein, calories and potassium. Talk to your dietitian or home care nurse about suitable foods.
• If the person can drink more fluids, aim for eight to 10 glasses of fluid daily. Sipping slowly helps fluids absorb better.
• Make sure water is not the only fluid taken. Serve a variety of drinks and jelly products such as Jello^™.
• Try frequent small meals instead of three large meals.
• Wash the anal area with mild soap and pat dry after each bowel movement.
• Apply a water-repellent product (Zincofax^™, Penaten Cream^™, A&D Cream^™, Silon^™) to the anal area to protect the skin.
• Be calm when diarrhea occurs. Try to reduce the person’s anxiety and embarrassment with the situation.
• Use protective pads on the bed to lessen embarrassment and help with clean-up.

Use a room deodorizer if odour is a problem.​