Incontinence

Incontinence is lack of control of the bladder (urine) or bowels (stool). With any type of incontinence, it's important to provide good skin care. Skin breakdown can be caused by pressure and prolonged contact with urine or bowel movement. Clean and dry skin is a good way to lower the risk of this skin breakdown.

Urinary incontinence

When you can't control the flow or release of urine it's called urinary incontinence. This can sometimes be temporary, for example, when it's due to an infection. However, when it lasts longer or is the result of the progress of a health condition, the best choice may be to use a catheter. A catheter is a flexible tube that is put in the bladder so the urine can drain into a specially designed bag. If this is the best option for you, your palliative and end-of-life care team will talk to you about how to look after it. You can also find help at Indwelling catheter: Care instructions.

Care and comfort

• Consider special incontinence garments  such as Stayfree, DryPlus, Attends, Poise, Ensure Guards. These are usually available at drugstores and supermarkets. They keep the bed dry and should be changed often. Talk to your home and community care nurse for advice.  You may be able to get financial assistance to cover these costs. Talk to your palliative and end-of-life care team if you have questions.
• To lower the risk of skin breakdown or irritation, use a water-repellent cream containing zinc oxide and silicone. For example, Zincofax, Penaten Cream, or A&D Cream. Apply the cream as needed whenever you change the incontinence garment. A silicone and zinc oxide spray such as Silon, may be available and may be easier to use.
• Wash your hands before and after touching the catheter, drainage bag, incontinence garments or washing the area where the catheter enters the body.
• Wash the area where the catheter enters the body at least once a day with soap and water. Gently pat it dry. This helps to protect the skin and prevent infection.
• Check the drainage tubing for kinks and make sure the drainage bag is below the level of the hips to help urine drain by gravity.
• Empty the drainage bag at least twice a day.

Ask for help if you notice:

• leaking around where the catheter enters the body
• blood in the urine
  
• diarrhea
• signs of bladder infection –
• urine becomes cloudy
• has an offensive smell
• fever
  

Constipation

Constipation means having difficulty passing stool or not having them as often as is usual for you. This can happen because of:

• ​medicines (such as opioids)
• less intake of fluids
• eating less
• low fibre in diet
• less physical activity

Stool is still produced even when you're not eating. Constipation is uncomfortable and may cause serious problems. This is why preventing it is very important.

Someone with constipation may have pain in the abdomen (belly). Their abdomen may look blown-up or bloated. Often with constipation there's a large amount of gas, burping, or feeling sick to the stomach (nausea). Occasionally headaches and confusion may also be present because of constipation.

Constipation must be assessed and verified by your home and community care nurse and doctor. They'll check to make sure there is no obstruction that may be interfering with the passing of stool.

Care and comfort

If you know what can cause constipation, you may be able to take steps to prevent it. Keeping the stage of the illness in mind, consider whether the following strategies might be tolerated.

• Keep a daily diary of bowel movements. Even if you have not been eating or drinking fluids much, contact your home and community care nurse if there hasn't been a bowel movement in 2 days.

• Try gradually increasing the intake of fibre and whole grain cereals and breads. At the same time, a large amount of fluid must be taken to move the fibre through the system.
• Increase fluid intake.
• Hot drinks with caffeine in the morning can encourage bowel movements.
• Walk, exercise, or move about in bed.
• Avoid foods that can cause constipation such as chocolate, cheese, and eggs.
• Take the prescribed laxatives especially if also taking opioids.
• Eat a variety of fruits and vegetables, and drink fruit juices every day. Prunes and prune juice are good choices. The following fruit laxative may help you 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

Mix these together and eat about 2 tablespoons each day.

Bowel routine

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

Take a bowel stimulant or laxative (for example, Senokot or Lactulose) 1 or 2 times each day.

• Laxatives stimulate increased bowel activity and help to create bowel movement.
• They can be purchased at the drugstore and their cost may be covered by a drug program.
• Talk to your home and community care nurse to find out which laxative is recommended.

Enemas

An enema is fluid inserted into the rectum to clean out the bowel. To give a small enema such as a Fleet enema, 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.
• Insert the tube gently into the rectum and squeeze the container.
• Let the person know that the enema may cause a feeling of pressure and cramps. Ask them to take deep breaths and hold the enema in as long as possible before letting it out.
• Go slowly but try not to stop if the person has only mild discomfort. Use the full enema or as much as the person can tolerate.
  

Ask for help if:

• there's blood in or around the anal area or stool
• there's no bowel movement within 1 day (24 hours) after taking a laxative
• there are persistent cramps or vomiting

Diarrhea

Diarrhea is loose or watery stool 3 or more times a day. There may or may not be discomfort. Diarrhea can be caused by infections, some medicines, surgery, fistulas, laxatives, side effects of chemotherapy, radiation therapy to the abdomen, or sometimes the underlying disease the person has.

Dehydration and low blood glucose (sugar) is a risk with severe diarrhea.

The body's balance of salts and chemicals called electrolytes can be upset by diarrhea. Avoid giving only clear liquids for more than 2 days in a row.

Some foods can make diarrhea worse while other foods may help slow it. Avoid foods that may stimulate or irritate the digestive tract. For example, whole grain bread and cereal, fried or greasy food, nuts, raw fruits or vegetables, rich pastries, strong spices and herbs, caffeinated foods or drinks, alcoholic or carbonated beverages, and tobacco products. Very hot or very cold foods can trigger diarrhea.

Diarrhea can also be the overflow of liquid stool around hard stool. In this case, it should be treated as constipation. Ask your home and community care nurse about this possibility.

Ask for help if:

• there are 6 or more loose bowel movements more than 2 days in a row.
• you notice blood in or around the anal area or the bowel movement.

Care and Comfort

Eating food and drinking fluids is the best choice for restoring the fluid balance of the body when it's possible.​

Food and fluids

• Serve a variety of drinks and jelly products, such as Jello, as fluid choices.
• Aim for 8 to 10 glasses of fluids daily if possible. Sipping slowly helps fluids absorb better.
• Choose foods high in protein, calories, and potassium. Talk to your dietitian or home and community care nurse about the kinds of foods to choose.
• Try frequent small meals instead of 3 large meals.

Skin care

• Wash the anal area with mild soap after each bowel movement and pat to dry.
• Apply a water-repellent product to the anal area to protect the skin. For example, Zincofax, Penaten Cream, A&D Cream, Silon.
  
• Be calm when diarrhea occurs. Try to lower anxiety and embarrassment with the situation.
• Use protective pads on the bed as these can help to lessen embarrassment and help with clean-up.
• Use a room deodorizer if odour is a problem. ​
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