The Bathroom Thing

[tinker]

My dhusband stroked in Aug 2007. It was massive left side and the drs did not expect him to make it. Well here we are. He has aphasia, but understands most everything. Watches news, sports, game shows, etc and follows them. His right side paralysis is bad. He does not like to get out of bed and needs two people to transfer him to the wheelchair. He is in a skilled nursing facility. He uses a diaper. My question is will he ever get out of the diaper. I cant tell if he is aware of the diaper and if he gets the bathroom concept. Has anyone ever run into this? Any ideas on how to talk to him about it? Anything i should be doing? I do see little subtle good changes in his alertness and was wondering if this could be a forever thing and the diapers are here to stay. Thank you.

[kanderson]

hi tinker. some people are able to regain their bowel and bladder control after a stroke, you can ask the nurses and aides if they can start retraining him. i had a catheter in after my stroke, after it was removed, i was able to go to the bedside commode or bathroom without problems. it all depends on areas damaged in the brain. i do know retraining does work. he may not be ready for it yet, if he doesnt want to get out of bed. the therapists can help you also. i would ask his doctor about it too. in the meantime diapers are the best thing for him as long as he is changed regularly to prevent skin breakdown and infections. NEVER GIVE UP HOPE THOUGH. does he let the staff know when he needs changing, if so he must feel the urge to go and when he is wet. good luck

[lliu]

hi tinker,

 

the body is still healing and the brain needs to be retrained to perform many functions. maybe your husband's doctor can recommend a urologist to find out if a urinary tract infection or kidny infection may be a problem. good luck and although recovery is slow, it's still progress!

[2ndChance]

I would ask the Speech Therapist to help you use a communication board to see if he even sensing his bowel/bladder signals.

[arogers]

Hi Tinker,

 

My husband's incontinence seems to be worse now than it was shortly after his strokes. (His last of three strokes was 3/05) He does wear a diaper at night. When he wakes up and needs to use the toilet he can't make it there in time. Using a urinal is out of the question since he has a vision cut that causes a lot of problems! When he has a bowel accident he claims not to have had any feeling of need before it was too late. One issue for him is that he moves slowly so if he is in the living room it takes too long for him to get to the bathroom and he is unable to "hold it". The doctor has told us it is a product of his strokes. Incidentally, his strokes have primarily affected his right side, vision, speech and memory. His right arm and leg have also been affected. However, at some time he suffered a less severe right-side stroke since he has a slight "droop" when he smiles on the left side and some weakness in his left leg.

 

He now suffers from vascular dementia as a result of his bleed, but the doctor doesn't feel the incontinence is a result of the dementia as much as it is the stroke itself.

 

Please keep in touch!

[RLT]

Tinker,

Sometimes I feel that most of my questions and difficulties are bathroom issues. I am thankful to have found one spot where people understand that poop is a big issue and don't respond by just saying, that's gross Ruth! So while I am not a poop expert I do have several years of experience and have asked a LOT of questions.

 

My husbands major strokes were on the left side leaving him with aphasia as well. I found that when he was in the hospitals he always ended up in diapers. At that time he knew when he needed to go to the bathroom but he could not communicate it. Then once he did get it communicated, it seems that nurses and aids are extremely slow in responding. The result was bladder and yeast infections which were overlooked by hospital staff until I made stink about it. Talking to staff and doctors may net some better results.

 

For a couple years post stroke, we found that my husband's bladder contol was taken care of with Ditropan which reduced the spasms in the bladder. There is hope to someday be out of diapers. Still we found it helpful to always have an emergancy kit including a urinal with us at all times.

 

For the last year my husband has shown signs of vasuclar dementia. He is in Depends all the time now. He does not feel the urge nor does he feel the wet or mess. Now our stratagy has changed. I have everything covered with waterproof pads. I am trying to get him into the routine of going to the bathroom to change the diapers. That is difficult for him to accept though when he does not feel the need. He only understands that stripping is a lot of work. (I am thinking of buying him a kilt.) Keeping him dry and clean is my biggest concern because I know how quickly the skin can break down. We have also learned that not all diapers are created equal. Even though the Depends brand is more expensive, they are softer. Some of the cheaper brands actually caused skin irritation.

 

It sounds like your husband is still dealing with some larger recovery issues. It is way too soon to know when or if he will get out of the diapers. I have found that speaking frankly with both my husband and others about the issue AND having a sense of humor has been the best way to deal with the changes we have gone through.

 

Ruth

[tinker]

 

Thank you so much for your replies. I received some really good information and at insight as to what i might expect in the future. I know that everyone is different but all the information helps me. I of course thought that he would be out of the diapers and he might, but i think it will take a longer time than i had anticipated. I have to get used to it. Thank you

[TNstroke61306]

The bathroom thing has been a subject I have wanted to ask or write about so many times. My husband stroked June 06 and he has gotten to the point of not having to wear the diapers. His stroke was also on the left side and he has aphasia too. Sometimes he has an accident when he is fatigued or sleepy but he has gotten to the point where he can use a urinal most every time to pee. The pooping thing is a lot better. I take him to the bathroom when he asks me to and transfer him from the wheelchair to the potty seat and there he goes!! So don't give up hope things can and will get better. :Clap-Hands: It takes a lot of patience and sometimes it runs out for me when I am in a hurry and he is not. But we have managed pretty well lately. Traveling is another story though. When we go visit my daughter we try and stay in a motel with a handicapped room so he can use the bathroom there. He can't get his chair in her bathroom and we have used his hemi walker to get in and out but with difficulty. He is back in therapy now and they are really working with him on using a walker sometimes. Always with assistance as he is not stable enough to do it by himself.

Keep on hoping for things to get better. I didn't think they ever would but slowly but surely he is coming back little by little.

Best wishes and HUGS!!!

 

Wendie

Wife and caretaker to George.

[cdewald]

I am glad everyone in here presented a different concept. This is indeed a hard subject to cover as it is easier to talk about clots than this subject. When I had my bi-lateral brain stem stroke, my change was to my left side...I did not have any idea there were muscles down there....It is strange to maybe think that, but I never thought of it and I was 52.

 

My urinary problems were "felt" immediately as it seemed I would go all the time and once I felt the "need" it was too late. Same with my bowels. A Year and a half out I have control, but not a long control as before my stroke. Gastritous seems to have evolved in massive amounts but I suspect the medications together with the muscular control inside me.

 

Every stroke sure has different effects on us it seems, but for me..the bowel and urine events are getting better.

[arogers]

I just ran across this again and we have been in the middle of a "bathroom crisis". (Donna, if you want to start a new thread go ahead!)

 

These things are so delicate, but I just need some support. Bill uses the bathroom to urinate. He has a vision cut to the right side that seems to affect everything - depth perception, everything. He also has a pretty severe "drip" - if you know what I mean. He also has vascular dementia - almost no short-term memory. I have asked and asked that he sit down on the toilet rather than standing, since I am SOOOO tired of cleaning up and it seems like he splatters all over. Another little "trick" for him is to use the sink in our bathroom. (This is not a post for the faint of heart.) This is REALLY irritating to me for all the obvious reasons. But he maintains it is just easier - duhhh....of course it is, for him.

 

I've got to say, I THINK this may have been an issue for a long time. As in, even as a little boy - somebody's mommy didn't do the training the way this mommy did!! So, I'm also fighting LONG held habits.

 

So, WHAT to do. The other day I got pretty ugly and he seemed depressed all day - even after I apologized. Didn't change anything either. Oh - and for more fun....He wears a Depends at night. It does help so save a drip from the bed to the toilet at night. Lately, I haven't been awakening when he goes. So, in the morning the Depends is on the floor next to the bed and he is nude in the bed. A VERY scarey situation. I am obviously not awakening because I'm exhausted. Do I need to put the buzzer back on the bed? Oh, and there are telltale signs he has removed the Depends BEFORE he has gone to the bathroom and the toilet seat is up so he hasn't been sitting down when he goes.

 

I guess I feel totally whipped on this issue. I have tried about everything I know to do but I'm not getting anyplace. The other day I told him I don't know how it is I can wear a bracelet he hasn't seen before and he notices, but he can't remember to use the toilet the way I have asked him to do and continues to make a mess.

 

And, oh, the bowel issue.....not getting any better, but I am now doing much better in prompting him to try and am careful about what we do after he's eaten and before he goes. He doesn't seem to have much feeling anymore so I have to help him. Last week I think he made it to the bathroom in time maybe twice. He does seem to be more aware of that now.

 

I don't know whether this is a rant or a plea for more hints - I guess a little of both!

[tom71]

tinker

this is a subject that is a little embarassing to talk about,but if he is like I was,while still in the hospital following the stroke,I knew when I needed to go but,I either could not physically get to the remote to call the the nurse,or I'd call and no one would come until it was too late and I'd wet myself,there was one time I can still remember,I had been pressing the button for a half hour and no one came,I managed to get out of bed and get to the telephone and I called my moms house,who called the rehab facility and gave them a piece of her mind,then when they finally came I got yelled at for being out of bed and sitting in the chair next to my bed.

 

God Bless,

 

tom

[avantgardener]

I am learning not to be embarrassed by anything anymore - I just want to know what to do and how I can best help Larry, and if anyone's sensibilities are offended then let

THEM try caregiving and see what they say then! So there.

 

For those who may not know, Larry stroked on his left side on 4/22/08 and is now in an SNF. He has aphasia and apraxia and can't communicate very well.

 

When Larry first had the stroke he had a Foley cathether for a couple of days, which was very painful and made him spasm. They took him off that our insistence, and he was in diapers, but voiding on his own. A few more days passed, and then he was suddenly unable urinate by himself - they started him on an "in/out" cathether. The protocol for that is that it's done every 4 hours "as needed". He tolerates the in/out cath much better than the Foley.

 

For the past couple of days, Larry has apparently been voiding on his own again - the diaper will be soaked, and he has not needed the in/out cath. Today he did need it again. I'm confused - why would he have been able to void on his own before, then couldn't, and now apparently can sometimes but not other times? I'm not sure what's going on. I have a bad feeling that the SNF is not doing the in/out cath often enough, and that his bladder is getting to the approx. 1000 cc's max capacity, and that it just "lets go" at that point.

 

I've asked the SNF for a urology consultation, because I frankly do not understand how all of this works and I want to know what's going on. He seems to be having pretty regulary bowel activity, but that is also with diapers (and he is on a laxative and a stool softener).

 

I'm not sure if he can tell when he needs to go or not. He does seem to know when his bladder is full and can tell me when he's uncomfortable. He can also tell when he's soiled or wet, but I don't know if he knows that before the fact or after.

 

One good thing is that he was a "sit-down" pee-er before the stroke, so hopefully he will keep that habit in days to come. The fact that I would share that is surely a measure of how much I trust the people here...I don't think Larry would be thrilled that I'm telling everyone this, but I honestly don't think that modesty has much place when we're dealing with practical matters. If he were to take up peeing in the sink I would not be thrilled, but it have to think it would be better than changing diapers!

 

I hadn't actually thought a whole lot about the ramifications of his function control (or lack thereof) when Larry comes home, but clearly this is a major issue. I hope he can regain some control - he's doing better with the physical recovery, at least on his left side, than with the aphasia, so I will let myself hope that this is one more thing that will improve.

 

Thank you for posting this - it's a major concern, and you should NOT be embarrassed! We are all just trying to do the best we can for the people we love, and there is no shame in that.

 

xxxoo

-Janine

[srademacher]

Just thought I'd add my two cents worth here:

 

You will find that in a nursing facility or a rehab hospital, the nursing staff don't have the time or the patience to keep checking on a patient to see if they need to go to the bathroom, so it's easier to put them in diapers and change them when and if they have the time.

 

From our experience, when my husband was in rehab, he couldn't talk or communicate his needs at all and when he did ring the buzzer, even though he was directly across from the nurses station, they would yell at him and tell him to stop ringing it. After they removed the catheter because of an infection, they tried using a urinal but weren't always able to do it on a regular basis, so I made it a point when I was there to see him to try to get him to use it. He still had the accidents in the diaper until he came home from rehab - then he got the one on one care he needed and we have had maybe only one or two incidents in 4 years, and a few in the shower incidents (that darn shower chair is a combination bedside commode and shower chair so it's just too comfortable)!!! :bouncing_off_wall:

 

When Gary was on the high blood pressure pills, which he really only needed while in rehab as the nurses drove him crazy, he seemed to urinate more often and we were up several times during the night taking him the urinal and emptying it. Once his blood pressure stabilized after getting home, and he got off the pills, he was able to use the urinal less often. I only take him to the toilet if he has to do the other or first thing in the morning before his shower, otherwise it is much easier for me to use the urinal than to transfer him when he has to go.

 

Hope this helps answer some of your questions about the "bathroom thing."

 

Sarah