When the Going Gets Tough - Don't Take Going to the Bathroom for Granted - Aging Brings Hardships

The plumber had just installed low-flow toilets at our home, subsidized by our drought-conscious city.  

The new commodes had the added benefit of being quieter with higher seats, so after our first "test drive," my husband and I both chuckled at how the humble upgrade could positively impact our quality of life.  

Most healthy individuals visit the bathroom between four and ten times a day. [1] For seniors who might be struggling with bathroom independence, that can be a daunting task physically, mentally, emotionally, and socially.  

Our digestive system is one of the many things that age has a tendency to affect. An annual prevalence of digestive issues associated with aging is thought to reach 40% in the elderly.

Bathroom Use Impacts Quality of Life

Giving older adults the tools and support they need to successfully manage this most basic function can tremendously impact their quality of life.  

The first step is to address the elephant in the (bath)room. Toileting is a universal function and one of our earliest childhood accomplishments. But it is also an intensely private matter. So, when a grown man or woman is having trouble making it in time, they may be understandably ashamed and reluctant to discuss the problem. Aging parent coach Judy Burkle says that family members, in particular, may feel uncomfortable bringing the topic up with the parent who potty trained them once upon a time.  

Family caregivers may be reluctant to help their parent because they want to protect their dignity. They may feel extreme sadness that this is just another sign their loved one is failing.

Help with Toileting Improves Health and Outlook on Life

However, research shows that when seniors have appropriate care for such tasks as going to the bathroom, their overall health and outlook on life improve. The ability to care for themselves with as little intervention as possible gives them an increased sense of dignity and accomplishment, validating their identity. The greater the sense of dignity, the greater the quality of life, and that is more important to many aging seniors than how long they live. [2]    

The causes for toileting troubles are myriad, ranging from confusion to mobility issues to visual impairment or illness. The family must discuss the matter with the primary care physician to determine the specific problem to determine the best solution.  

• Cognitive: they may forget they need to use the bathroom, forget where it is, or not recognize the toilet (for example, the gentleman with dementia who used the sofa instead, raising and then carefully lowering the seat cushion when he was finished)   
• Mobility: trouble walking quickly enough, resulting in accidents
• Visual: depth perception  
• Verbal: difficulty communicating their need to go
• Emotional: discouragement, embarrassment, fear of falling, or failure
• Physical: difficulty managing clothing or toilet paper, muscle weakness
• Illness: temporary incontinence due to a urinary tract infection (UTI) or other ailments
• Medical: side effects from medications

Family Caregivers Should Remain Calm

Solutions will depend on the cause, but a caring, respectful, and patient attitude will go far in ensuring their success.  

Your role is to provide just the amount of support your aging loved one needs, but no more. And to approach the job of going to the bathroom calmly and professionally. 

Use their name, not your relationship (Mom, Grandma), or—worse—treat them like children with condescending terms such as "honey" or "dear."  

Avoid using pads or briefs unless truly necessary. If they're embarrassed, a light sense of humor may be welcome; let them know you understand and it's okay. 

Minimize their understandable distress by cleaning up accidents discreetly and promptly.  

A good start towards understanding and compassion is for the non-disabled caregiver to pause and think through all the mini-tasks required to succeed at something we might personally take for granted. Dementia expert Teepa Snow breaks down the process of toileting into about twenty or more specific steps.  

Tips for Assisting Loved One in the Bathroom

The video How to Assist Someone in Going to the Bathroom walks through the various steps with helpful tips such as:

• Use clear communication and short sentences to explain the next step, for example, "I'm going to help you stand up now" and "Lean forward when you're ready." Match your visual, verbal, and physical cues (e.g., point, say where you're going, and guide them gently).
• Allow them to walk at their own pace but stay nearby to prevent a fall. Move away from their field of view but close enough to assist once they are safely seated
• Guide them carefully to the seat, perhaps with an arm around them. Backward motion can be physically challenging, so sitting down abruptly can frighten or startle them, inhibiting their ability to go.
• Help them to the bathroom at regular intervals.
• Offer matter-of-fact encouragement. "Now turn slowly; that's good."  
• Elastic pants are much easier to adjust than those with buttons, or zippers.

Other ideas to consider include the following:

1. Make signs to hang on the bathroom
2. Paint the seat a bright color, so it's easier to see
3. Keep a urine bottle handy and/or provide a bedside commode
4. Use a bidet, toilet tissue aid, or wet wipes for clean-up
5. Dab Vapor-Rub under your nose for handling those messy jobs

Bathrooms Can Be Dangerous

Be sure to keep safety in mind. Bathrooms can be dangerous, with their hard surfaces and tight quarters. Sitting down and standing up can cause blood pressure changes, leading to dizziness and a possible fall.  

Ensure the bathroom path is kept clear; remove any rugs or floor mats; use automatic night lights; and install grab bars. A raised toilet with handles can be a godsend.

Professional Caregivers Help but Be Appreciative

If you are blessed to have professional caregivers helping your loved one, be sure to tell them how much you appreciate their providing this less-than-desirable but very important service. A little gratitude—maybe even a handwritten note or Starbucks gift card—can go a long way to making sure your parent receives cheerful and compassionate care.   

For family caregivers, Buerkle suggests easing the stress and burden of the caregiving role by setting aside time for yourself.

Ensure that you are setting some time aside for yourself, so you have the patience and the empathy that you need to be kind to your aging parent. Remind yourself often that they would not choose this situation. Find a support group with like-minded people who can share their experiences and tips with you. Make sure to take care of yourself so you can help your aging parent in this challenging area.

As you consider your aging parent's condition, taking care of your physical well-being is a vital investment in your own future.  

In the video Why Fitness Matters, fitness coach Mark Vacanti talks about one of the top reasons someone enters assisted living.

One of the top reasons why a person checks into assisted living is because they can't get off the toilet. They can't do a half rep of a bodyweight squat, so they have to have someone taking care of them.

He encourages baby boomers. 

You have a huge advantage. You have grit. You've had hardships in your life, and that creates strength. Diamonds are built under pressure. You can dig into that piece of your body and of your soul and put out the effort to make this change. 

Aging brings changes whether we like it or not. When it comes to the bathroom, constipation occurs more frequently and is the most typical age-related change. 

Health Issues in the Bathroom

Constipation is typically characterized by fewer bowel movements (two or fewer per week), at least 25% of the time, straining, frequently incomplete evacuation (meaning returning to finish the process in an hour or less), and a hard stool.

There are a number of causes for this, such as low muscle tone in the bowel and abdominal muscles, slowed peristalsis (involuntary contraction of the intestinal muscles), inactivity (sedentary lifestyle or travel), insufficient fluid intake, an excess of dairy products, a deficiency in dietary fiber (fruits and vegetables), and the use of some medications.

Some older adults may faint on the toilet, which can mean the individual falls, leading to injury. "Defecation syncope" is the official term for fainting while trying for No. 2.

As we get older, it's also common to experience occasional diarrhea. This isn't necessarily related to getting older per se, but rather to eating foods that "disagree" with us, ingesting contaminated food products, getting the intestinal flu or a "GI virus," engaging in strenuous exercise with excessive fluid consumption, or experiencing food allergies.

Diverticular disease and colon cancer are two disorders that can develop in the elderly. Other issues include dyspepsia, irritable bowel syndrome, inflammatory bowel disease (Crohn's disease and ulcerative colitis), celiac disease, and GERD.

Remember several types of urinary incontinence that can get in the way as we get older.

At some point, the older adult may not be able to maintain complete independence without assistance from someone else. Family members may be unable to provide the necessary care to help their loved one with bathroom activities and other routine daily living activities we often take for granted. 

Professional in-home care providers may be necessary to provide the quality care your loved one deserves. It's not cheap, and Medicare and supplements will not pay for this type of long-term health care. 

Assisted living may be considered as well; however, that is also expensive and not covered by traditional health insurance and Medicare. Long-Term Care Insurance will pay for this care, but it must be purchased when someone is fairly healthy; in fact, it is usually obtained when someone is in their 50s. Medicaid is generally not an answer as it requires the individual to have little or no income and assets.

For an older loved one, you and the rest of the family will do your best to provide the necessary help to allow them to live as independently as possible, including in the bathroom.

The next question is to ask yourself, are you ready when you get older?

 [1] "What Your Bladder Is Trying to Tell You About Your Health," Cleveland Clinic HealthEssentials, July 17, 2019

 https://health.clevelandclinic.org/what-your-bladder-is-trying-to-tell-you-about-your-health-2/  

 [2] Bell, S. P., Patel, N., Patel, N., Sonani, R., Badheka, A., Forman, D. E. (January 2016). Care of Older Adults. Journal of Geriatric Cardiology, 13(1):1-7. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753005/