Full Episode Transcript

Nancy Treaster
We both wish we knew more about incontinence before it began.

Sue Ryan
We sure do. For Incontinence, we’ve actually created a five -part series because there’s a lot going on with Incontinence.

Nancy Treaster
Yes there is and it’s coming.

Sue Ryan
It is coming. For this series, we’re helping you, in this series, we’re helping you preserve your care receiver’s dignity and we’re helping you become prepared mentally, physically, and emotionally for this part of your caregiving journey. I mentioned five episodes. The episodes are episode nine, preparing for incontinence. Episode 10, a phrase we coined pre -incontinence and the very beginning of incontinence. Episode 11, cleaning our care receiver and urinary incontinence. Episode 12, bed bound and bowel movement incontinence. And episode 13, incontinence overnight. Nancy and I talk about in our podcasts that we are bringing you the good, the bad, and the ugly and this series can definitely qualify as some of the ugly. This is the fourth in our five part series. And in this series or in this podcast, okay, in this podcast episode, we’re covering two topics. Nancy, are you ready?

Nancy Treaster
Yes, ma ‘am.

Nancy Treaster
I’m ready. Before we get into the topics, Sue, let’s talk a bit about bed bound and mobile bowel movement. Before we get into the series, Sue, let’s, you’ve already said good, the bad, the ugly. This is probably the most difficult of all the topics. Overnight is also very difficult, but this is probably the most difficult piece. It is.

 

Sue Ryan
This is challenging, yes.

Nancy Treaster
This is another inflection point. So some people, we’ve mentioned this in the earlier episodes, when you get to urinary incontinence, some people realize that they’ve reached a boundary or line they’re not comfortable crossing. And that’s okay. Give yourself some grace. Some people look into care communities at that point, or they bring in professional caregivers. Some people make it through the urinary incontinence and cleaning their care receiver through that type of incontinence. But when we get to bowel incontinence, that is another inflection point and perfectly reasonable that it is. So also keep that in mind.

Sue Ryan
I was going to add, or why don’t you go ahead and add that it’s not just that you’re uncomfortable with it. You physically may not be able to. So add that one in there. So go back to say that again. Okay.

Nancy Treaster
Okay. All right.

Nancy Treaster
So for a lot of people, this is another inflection point, changing the bowel movement. And that makes perfectly good sense. It could be that it’s a mental block for you. This is, you just can’t do this and that’s perfectly fine as a reasonable boundary to have. Or it could be that it’s physically more difficult for you to deal with this type of, especially when you see what’s involved with bed bound. Let’s be very clear, that’s very physical. So these topics that we’re gonna cover today also have a pretty strong physical aspect. So perfectly understandable that this might be a new inflection point for you. So check yourself, as we’ve said before. All right, you ready to get to the first topic, Sue?

Sue Ryan
The topic that I’m going to be covering is changing our care receiver when they are bed bound, or if they’ve been in a wheelchair and you’re gonna be changing them. And when I got started with that, I began writing out all of the things that I experienced and I was walking through and I was very methodical and it was getting more and more and more and more. And I thought, you know, if a picture’s worth a thousand words, and this is getting pretty much over a thousand words, wonder if there might be a video someone has done about changing a bedbound care receiver. And fortunately, I found one. These amazing women, I want to make sure I get their names correctly, Brenda Kazir and Nancy Hyerman. And they created the YouTube channel, The Hospice Care Plan. They have over 45 years as palliative care and hospice care nurses. They created a video that is extremely responsible about changing our bed bound care receiver. And even they, when they were talking about it, they said, the first time we recorded it, it was well over nine minutes. There’s a lot that’s involved with it. And I shared this with Nancy and I said, tell me what your thoughts are. And Nancy, tell them what your thoughts were.

Nancy Treaster
Right, well, first, the reason Sue’s covering bedbound as a topic is I have an orderly idea. My husband’s not bedbound, I’ve never experienced this. So I was actually quite interested in myself to hear how do you handle a bedbound care receiver? Because a care receiver might be bedbound permanently towards the end of their journey or for some other physical reason, but it might be temporary. When my husband had COVID, he was bedbound.

Now we managed to get him up to change him, but it was difficult because I didn’t have a clue what to do. So it could be a temporary bed bound situation, but it’s important to understand what’s involved. So Sue sent me this video and say, she said, I’ve been trying to write this down, but this is getting really long. It’s like a thousand word essay. So I watched the video and I thought, my goodness, she’s exactly right. This is, well, there’s just too much to cover just verbally like we do in our podcast. So I thought that is this.

Nancy Treaster
This is very instructive, the video was and is, we’re gonna obviously share it with you. And also, I’m covering bowel movement, how to change a bowel movement in a mobile care receiver. Maybe I can find the same kind of thing. Wouldn’t that be awesome? So I searched all over the internet. I found some people talking about how to change, depends, but no one covering the topic the way it needed to be covered. They were way too high level, which is part of why Sue and I have this podcast because there’s a lot of way too high level information out there. And so I thought, great, I’ll just make my own video.

Nancy Treaster
Do not laugh at me, Sue. So I thought, what do I have that I could put a on? We’re on this journey for sure. What do I have that I could put a depend on to show our listeners who are watching on YouTube or Spotify how to change a depend? And I thought, I have Teddy. Well, do you know who Teddy is? No, you don’t. Well.

Sue Ryan
I’m laughing with you, Nancy.

Sue Ryan
We’re all on this journey together, Nancy. Remember that.

Nancy Treaster
This is Teddy. I got him when I was two. He’s 61 years old, but he has two legs. So he can be, I have a depend to put on him. So I tried it by myself. I put a depend on him and tried to figure out how to show you Teddy’s not a good idea. He doesn’t work for that. So Teddy’s out, but at least I tried. And so I called Sue to, well, I called Sue to explain that I had tried to use Teddy and Teddy didn’t work.

Sue Ryan
But she did have a backup plan.

Nancy Treaster
And thank goodness Sue volunteered to say, I’ll do it with you. So Sue and I’ve created a video of how to change your bowel movement with Sue as the model versus Teddy, and it works much better. So thank you, Sue.

Sue Ryan
You’re very welcome. Needless to say, needless to say, you know, we’re not taking this topic lightly. What we are identified though for you is that there is so much going on with these and the more you can become aware of it, think about it, kind of go through it, talk with people about it, talk to professional caregivers about it, do all the things to be aware.

Nancy Treaster
All right, back to your topic.

Sue Ryan 

The less surprised there is when you finally get to this, the better it’s going to be because there is a lot going on. And as Nancy mentioned in an earlier podcast episode, when she was going to be having to do more care with her husband, she went out and started exercising to build upper body strength in order to be able to support him standing up. So all of the things that we’re gonna be talking about are, as Nancy said, inflection points and things to be preparing for, as well as things to be knowing kind of what to do in it. So again, in an earlier episode, and we’re gonna put in the show notes, we’ll put the link to the video, we’ll put the episodes for these, but I talked about the fact that I journaled a lot. I wrote down things of observations all along the journey. For example, when my care receivers started looking like they needed to use the restroom, it’s like, did they look? What were some of the signs? What were the times of day?

And this is another area for it for you to be very observant of it because as they are less able when they become bed bound or the diagnosis advances and they can’t communicate as well, when they’re bed bound, they’re in a different physical position. So they could be physically uncomfortable or it could be a sign that they need to use the restroom. And so we want to make sure that we’re still journaling signs that we see so that it’s helpful for us as well as for our care receivers.

I mean, as far as like professional caregivers, other support team members. Another thing that’s really, really important is our physical presence. When we’re used to our care receiver being mobile, kind of around more of our eye height, that’s one thing. As their height diminishes when they’re either in a wheelchair or when they’re bed bound, they’re not at our eye level. And what I would do with my care receivers is I would begin gently talking to them, very positive sound, very positive look, and I would start getting lower and lower toward more being at eye level with them by the time I was where they were. So was as easy as possible for them to see me. Because vision is often impaired, it becomes more impaired and depth perception becomes more impaired with diagnoses of dementia. I was very careful about not feeling like I was over them and that I might be an imposing image that might be fearful for the and that I didn’t get too close too quickly. they felt like, wait a minute. So at any rate, so your physical presence is really important. And the other part is we’re making contact with them and then it’s our tone of voice, calming tone of voice, very easy with them, very gently explaining every single thing we’re doing. We’re not making rushed movements and we’re also not rushing our speech. We’re gonna do this with, we’re also if we have someone else with them.

We’re talking with our care receiver, even if we’re also talking with someone who’s a member of the support team. Another huge part of this that was very important, and I’ve got several examples for it, is our loved one’s physical size and the bed size. And when we are changing our care receiver, it’s important that, especially when they’re bed bound, we need to be able to be working with them on either side.

And if, for example, you have a king size bed and they’re bed bound, it’s going to be difficult to get to the other side. And so you may want to consider a different size bed. One of my care receivers was quite petite. She fit easily in the bed and it was easy to roll her over on her side and roll her over on the other side. And there were even if she flipped over on her front accidentally, she wouldn’t be going off of the bed. So that was that was very helpful with my husband. What became apparent, couldn’t use the king size bed way too big. On a smaller bed, he could still fall over and fall out. So he needed the rails. The other thing is because he was a larger person, they show in the video about stuffing pillows at their back. Because of his size, the pillows wouldn’t hold him up. So I went, I literally bought, and you can buy them, a wedge pillow to wedge his back up so that he can be relaxed. And then he was also able to hold on to the railing.

Then one of the creative things that we did with a friend of mine is she had the twin bed for her mom and her mom was an okay size for the bed. But we wanted to make sure she couldn’t fall out. So we went out, you can buy wheels that you take, portable, you know, the wheels that can go on the bottom of a bed. So we rearranged the furniture in the bedroom, put the wheels on the bed, moved the bed up to the wall and you know, the two walls. So she was right there. So if she tipped over, it was against a wall. She wasn’t going to get hurt. And then all we did was turn the bed around.

Sue Ryan
So we were able to do that, a little extra step, but then you don’t have to buy the bed on rails and things like that. So very, very important for recognizing their size and that. And then in the beginning, the thing that I did is that, even with the YouTube videos, and Nancy, I mean, you chime in on this, the first few times you do it, it’s not pretty. I was not good at it. And one of the things that I recognized when I was looking at what you know, and I was asking people what’s it going to be like and they’re telling me, mean, nobody’s showing me and there weren’t videos. So I was like, you know, when I’ve tried a lot of things for the first time, the outcome is not what I anticipated. And so I brought in a professional caregiver. I wanted to not potentially harm my loved one when I was practicing this. I also figured out like, you know, OK, I’ve got to move this, do this, do this, do this and the whole process of it.

So bringing someone else in who can also, by the way, when Nancy talked about those inflection points, there’s somebody who can tell you whether they think that you are physically able to do this on your own. And they can tell you that because they know, they do it all the time. They physically know how to move their body, how to bend. My uncle taught me a very valuable lesson with his mom, my grandmother that she was petite and when he would try to lift her and bend and things like that, he thought he was doing fine. And then he started, his knees were hurting, his back was hurting. They finally brought somebody in and she said, well, you’re doing it all wrong. Cause he hadn’t been taught how to do that. So size isn’t always a determinant. So really make sure that you are getting support in learning how to do this. And you’re not trying to do it all on your own if you don’t have to.

Nancy Treaster 

Right? Now, urinary didn’t make me quite as nervous outside of the, which we talk about in the previous episode, the cleaning your care receiver episode, the tearing and snipping of the pull -up depend. Not so easy. Okay. But beside that, the urinary stuff, pretty straightforward. The bowel incontinence, you’re actually scared and not the first time, but frankly, once you do it the first time and it’s a mess, then every time it happens, you have in the back of your mind,

Sue Ryan
Yes. Yeah.

Nancy Treaster
At the beginning, good grief I don’t know how to do this. This is gonna be a big mess. I’m just gonna make a mess of it. It’s just gonna be a disaster. And it might be for a few times. So once you get the hang of it, and that’s why we wanna help instruct you so that you don’t have to make it up on your own, once you get the hang of it, now it doesn’t bother me at all. It’s no big deal. But it is scary the first however many times until you get good at it.

Sue Ryan
And it’s hard. It’s, yeah, it’s not. It’s like doing anything else like that. And I’ll give one final, very quick bonus tip, Nancy, and we’ll turn it over to you. My bonus tip is of all of my care receivers who I have changed, none of them have liked a cool washcloth or a cool white. And we talk about that in another episode. Warm them up so that they’re a minimum of room temperature or a little bit warmer.

Nancy Treaster
Mm

Sue Ryan
How about topic two, Nancy?

Nancy Treaster
Thank you, Sue. Yes, so you’ll see the video which goes through and is extremely well done on how to change a bedbound care receiver in our, we’ll have it in the show notes and we’ll put it in our YouTube channel as well. Second topic is changing a mobile care receiver’s bowel movement. And I’m gonna cover this in two tips. First tip is how to get sort of in the right position to do it and what to expect.

Sue Ryan
It really is.

Nancy Treaster
And the second tip is actually doing it. So in the first tip, I would say the first thing you wanna do is get your care receiver into the bathroom as soon as you realize that there’s been a bowel movement. Don’t let them sit down if they’re standing. Don’t let them sit down because that creates an additional level of mess to clean up. Walk them very nicely to the bathroom. Check your body language, check your words.

Let’s go get you some clean underwear. Let’s go get you cleaned up. Come on, come with me. Let’s go to the bathroom. You wanna get in, no, and calm and no matter how you feel inside, put on your actor, best actor or best actress face because you wanna try to, they’re already, they’re embarrassed, especially at the beginning, they’re embarrassed, they’re ashamed. This is not something they want somebody else to have to deal with any more than you wanna be dealing with it.

 

Sue Ryan
No panic.

Nancy Treaster
We’re trying to create as calm and dignified a process as possible. So walk them into the bathroom, help them make their way into the bathroom. You wanna be in the bathroom because compared to unlike just a wet depends, this could possibly and will at least initially and heck it happened to us yesterday and it was me and a caregiver both and we still made a mess.

It still happens periodically if you’re not paying enough attention. Frankly, you get little cocky and then it makes a bigger mess. So, you know, it’s gonna make a mess for sometimes. And when it does, it sure is easier to clean up the tile in a bathroom floor than it is any other part of your house. It’s a more confined area and it’s easier to clean up. So you want them in a more confined area so that they can’t move around as much. And think about it, particularly at the beginning, they don’t know what’s happening any more than you do. So…you’re putting them in a position where someone is taking off their adaptive clothing, ripping on their underwear, and they’re standing up and they’re not always as cooperative in terms of just standing there and letting you do what you need to do. Everybody gets in a better habit of it and that does ease up and they get more compliant. But at the beginning, the calmer your voice is, the more instructive you are, just like Sue said at the beginning, the more you say, here’s what we’re getting ready to do.

If you’ll stand right here, that would be great. You want to be as instructive and as nice and as thoughtful and as thankful as you can be. That helps create the calmer situation. The other thing you want to do is as soon as you get in that bathroom, you want to turn the hot water on because you want to start as Sue described, warming things up and getting your, the bathroom laid out. So you want to get your cleaning products laid out on the counter. You want to get your scissors if you’re not comfortable ripping up the sides of their pants, scissors out, gloves on, hot water running so it’s getting hot so that you’re ready to, when you’re ready, you’re ready. Everything’s in place to get going. Now at the beginning, they’re, think about this, someone’s coming at you, you’re, put yourself in their shoes for just a minute. Someone’s coming at you. You’re not sitting down quietly. They’re ripping off your pants or whatever clothes you have on. They’re, coming at you trying to take your underwear off, you’re gonna feel like you need to defend yourself, at least at the beginning, until they understand what’s going on here, and it starts to become more routine. So don’t be surprised if there’s some battling going on early on. That passes for what that’s worth. They do get comfortable, more comfortable, at least in my experience with the routine, and it’s not such a big deal. If you have someone with you, like I had a caregiver yesterday and we were doing this together, that’s two people coming at them at the same time.

So don’t be surprised if they get defensive. Two people are coming at me at the same time. We made the mistake early on of talking to each other and not talking to my husband. Too much talking to each other about what’s happening and not including them in a nice calm voice doesn’t create a calm environment. So more discussion with them, less discussion amongst yourselves if there’s more than one person. So that’s tip one in terms of just creating the best environment possible to make this as easy as possible. So let’s move on to tip two. Tip two is actually changing the depend with a bowel movement. This is best done standing up as I said, please do your best not to get let them sit down or you’re just gonna be more, there’s more cleaning to be done. And here you want to lay down one of those disposable incontinence pads or two or three, whatever you decide after you’ve done this a few times creates enough of a protected area that the chances are if something falls on the floor, it’s falling on one of these disposable pads. So put a disposable pad or two or three down on the floor. Keep one ready on the counter because if something does fall on the pad, you want to cover it up quickly so that you’re not stepping in it and they’re not stepping in it. So be prepared to cover it up quickly.

You’re going to remove the depends from behind them. So you’re going to step up and you’ll see this in the video, you’re to step up behind them, you’re going to take cut one side and tell them what you’re doing the whole time. I’m going to take your underwear off, you’re going to cut up one side of the depend and then you’re going to take that side and actually fold it inside into the other side of the depend.

So now you’re sort of cradled, if you will, the bowel movement. Hold that steady. You’re gonna use your scissors and you’re gonna get pretty close to having clipped off the other piece, the other side of the depends. And when you get there, grab that front end of that side that depend as well. Finish cutting. Now you’ve got the front, the back pulled together like an envelope and you’re still holding the front. Take your free hand, take the front.

separate them and then just go down between their legs and take it off behind them. Now I’ve usually got a trash can, a small trash can with a liner right behind my husband’s legs. And so when I take it down between his legs, I guide it into the trash can and I leave the trash can pushed aside but pretty much right there because now you’ve got your wipes and you’re gonna start wiping them up. If it’s a man, you can wipe whole backside and put all those dirty cleaning products into the trash can. If it’s a woman, you wanna wipe front to back because you don’t wanna risk getting any stool inside of them. It can create yeast infections and urinary tract infections. So we wanna wipe front to back. And we wanna get them as clean as we can and put those dirty cleaning products into the trash can. Now here, I use a product called scrubs and scrubs are non rinse bathing wipes and that scrubs is ZZ at the end. S C S C R B U ZZ. You put them under warm water hot water I use put them under hot water. We put them on top of a paper towel to give it a little more breath and they are what you sweat them squeeze them out a little bit and there they get soapy.

Sue Ryan
We’ll put this in the show notes.

Nancy Treaster

So you’re literally, like a warm soapy washcloth you’re soaping them up and cleaning them up with. The great thing about non -rinse bathing wipes is there’s no rinsing involved. As soon as you get them all cleaned up, you take a towel, you dry them off and you’re done. Now Sue loves to bring this topic up so I don’t wanna pretend that I’m not going to ignore it. It’s very important to her. It is the truth too.

Periodically, and it doesn’t happen all that much at my house, but periodically, just like when you’re changing, if you remember changing a baby, the warm, wet, soapy washcloth that you’re using causes, I know you’re, because if I didn’t tell them, you’re gonna tell them, can cause them to want to pee. So just when you think you’ve got everything cleaned up, now all of a sudden you have an additional thing.

Sue Ryan
They’re gonna be so glad you tell them this tip.

Nancy Treaster
So be prepared with that towel as you’re drying. If they start holding themselves or you think they’re getting ready to pee, you can use that to put right in front of them and try to get as much of that as you possibly can or at least direct it where it’s going on the disposable pads and kind of not, just don’t let them wander off is what I’m saying without.

Sue Ryan
Yeah. And why is that a tip Nancy? Because it does happen.

Nancy Treaster
But it does happen, right? so don’t think just because you’ve got them cleaned up that they’re now good to go wander off. You want to quickly put that new depend on right then and there because of this possible additional thing you might have to be dealing with. We take the depend at that point and the trash can. I use a scented small trash can liner or lemon scented liner. Tie those up. And then I have an adult incontinence can, disposable incontinence can out in my garage and we take all of the dirty depends not the we don’t take the wet ones we just throw them in the garbage people my mother was freaked out about what depends she put everything outside but we we take those just the dirty ones the bowel movements and put those in the garage incontinence can I don’t find the urinary ones we take our garbage out every night so I don’t find that they that they smell but the other ones definitely do so you want them out of your house preferably.

I wanna just reiterate, cause we’re really done here and you’ll see this all in the video, but nervous wreck the first bunch of times that you do this, you think, my goodness, I don’t have it, I can’t do this, it’s gonna be a big mess and it might be, but no, just like anything, once you get good, get comfortable with it and get good at it, once your care receiver knows what’s happening, they’ll be more cooperative, then it really, like I said, it’s not a big deal once you’ve got it in your mind.

And if it is a big deal, that’s okay too. Because in your mind, this may not be something you can deal with. That’s part of why we wanna do this episode.

Sue Ryan

And that’s why we say mental, physical, and emotional. There are on all levels, there are issues. It’s reasonable you would have. Give yourself grace.

Nancy Treaster
Right, and if this isn’t something, if you watch this episode, it might be a good indicator of, think I can do that, or you know what, no way can I do that. That’s okay too. So just wanna make sure everybody understands that you gotta check yourself. That’s who’s important in this and whether or not this is something you can do. Now Sue also made the point, and it’s a good one. When you start to have these inflection points or transitions, it’s a good time if you don’t have professional caregivers in your home to hire one even temporarily to… go through a few days at your house and help you through this process. I’ll give you two seconds on what the professional caregivers do. my professional caregiver, just recently I had one, a temporary one in, and she rips up one side of the pen, she leaves it ripped, she doesn’t do anything I just said. She does the other part and she just lets it fall on the disposable pad. That’s her way of doing it, have at it. So everybody’s a little different, you can learn from those people. Everybody’s got a little different way of doing it.

Sue Ryan
They also though, and this was one of the things that we talked about, they have physically been trained. Professional caregivers have been trained how to physically roll someone, lean over them, lift it, because if you’ve got somebody in a wheelchair, you’ve got to get them up, know, get their arms around, lift up, things like that. They’ve been professionally trained. It’s reasonable you have not been. seriously consider getting help to come in to help you learn.

to help you evaluate and to help you be able to have the right kind of conversation about whether or not this is something that you feel you can handle by yourself or if it’s a conversation to have with other family members and loved ones.

Nancy Treaster
Another awesome point, Sue, we talked earlier about inflection points. It’s not just an inflection point for you as the main caregiver, primary caregiver, it’s an inflection point for family members who maybe were up for urinary incontinence, but now we’ve crossed another line. So another conversation to have with any other caregivers you’re bringing in the house. Okay, I think we’re ready to summarize.

Nancy Treaster
Today, in this episode, we covered two topics, changing a bed bound care receiver and changing a mobile care receivers bowel movements. These are challenging parts of your journey for sure. If you have tips beyond the ones that we have that you think would help other people, please go out to our Facebook page, our Instagram page and leave your tips so other people can see them. So we can see them, that would be great.

If you like our podcast, please go out and subscribe, rate and review our podcast. It makes it that much easier for other people to find it. And if there are any products, and there are of course, that we discuss in any podcast, we all put, if there are any products that we discuss in any episode, we always put links to those products in the show notes. We’ve talked about this a lot and

So, but let’s reiterate, this is a challenging part of your journey, but I hope with this, this is a challenging part of your journey. With this information, you’ll be better prepared to figure out how it fits into your caregiving journey.

Sue Ryan
We’re all on this journey together.

Nancy Treaster
Yes, we are.