Male relative late 70s faeces everywhere when using toilet

[limetrees32]

Undx yet with Alzheimer's or similar.
Using fingers when opening bowels , not wiping effectively or cleaning hands properly.
Poo on door handles ,taps , trousers.
Any advice ?

My mum went through a stage of this as her dementia progressed, not helped by constipation; it is very difficult. (The next stage was permanent incontinence pads).
The "smearing" I think was just her noticing the faeces on her hands and trying ineffectively to wipe it off on sink, towels etc.

Have a good kit of clean up materials available: disinfectant wipes/large wet wipes, bin bags, paper towels/blue roll, spare pants, so any messes can be efficiently cleared up. You can order this from incontinence suppliers. Also keep his nails trimmed very short, if he will let you.

He may have no oomph to push it out. Soft stool can easily just sit there and the only reason it's not hard is that he is fishing it out.

If it's not constipation, then the introduction of fingers into the rectum might be a sex-related thing, but obviously there's a lack of inhibition around this and the poo everywhere/ lack of proper hygiene afterwards.

Support the partner in whatever she decides. I can't imagine a cleaner to deal with what is effectively a hazmat situation would come cheap.

Also, if it is dementia related, I'm afraid it's unlikely he will learn to use a new type of toilet or system at this stage.

This was one of the symptoms of my FIL's dementia. He forgot how to do certain everyday things, one was wiping after using the toilet. He would have poo on his hands and it got everywhere.

He may have no oomph to push it out. Soft stool can easily just sit there and the only reason it's not hard is that he is fishing it out.
I actually think this may be the case.
But I'm and apologies for TMI ,I have similar.
I have found taking magnesium as a supplement very helpful.
But he has heart problems and I believe magnesium is contra indicated.

Emotion isn’t the same as disinhibition.

@Fiftyandme don't hold back on the helpful advice and empathetic comments will you.

@Stillawake2023 We think it is a sensory need linked to dementia.

I keep mulling over your comment .One of the other behaviours is pressing his lower back ( think horse rubbing itself against a gate ) or rubbing his legs .He complains ( a lot) about itching legs that keep him awake ,stop him eating,stop him getting out of bed .
Nothing obvious to be seen .

I'm wondering if you found any way to meet the sensory need ? I'm thinking possibly some sort of massage ,head and /or hands /feet ?

His partner is at her wits end .

His continence per se doesn't seem the issue. He's going to the loo, but just forgoing either toilet paper or handwashing. Which is a symptom of his cognitive decline. As obviously it's not normal to be unbothered by touching and smearing poo. And unable to clean up.

He needs a dementia assessment and adult social care assessment.

This is all very difficult and I really sympathise. My father had dementia. He was eventually living in residential care. When living at home hygiene became a problem early on (not changing his clothes, underwear covered in brown marks and so on). Later his confusion included inappropriate use of the toilet - he would put the stool in his pocket rather than flush or bring it back into his room and put it in the bedroom bin. I dont have an answer but I am saying its more likely confusion - dementia and not constipation. We all just worked to ensure he was clean, we couldnt change his behaviour.

I agree @BillieWiper .He's had a CT brain scan - not specifically for dementia ,prompted by GP referral regarding a range of things ,of which one ,worryingly,is micro absences/freezing .
He's been referred for MRI and on waiting list for memory clinic .
CT showed nothing of note ,

Good point about adult care assessment,they might recommend carers ? He'd be meeting the cost I think as he has a good pension .

@redwinecheeseandothersnacks oh gosh ,that sounds even worse .
I do agree ,it's about managing it ,I don't think the behaviour will be easily /or at all possible to change .

Agree. Op as awful as it is, you are thinking of ways to stop it, I think you need to move to managing it perhaps? My MIL still had emotions, they don't get immediately switched off but some of that emotion was her taking a swing at her son whilst he was doing some personal care as she was presumably scared and didn't know who he was.

It's also not linear the old dementia so some areas he may seem to be holding up well but others not.

Micro absences like TIAs (often called "mini strokes")? There is a type of dementia caused by the brain being damaged by strokes. Hopefully the doctors can give good advice.

It does sound like supervision and prompting with using the toilet is going to be necessary. But the continence team might have some good ideas. Even something like positioning (having his feet up so he can push faeces out rather than manually evacuating) or taking a bulking agent. They will have seen this many times before and may have found strategies we wouldn't think of.

@TorroFerney good points
And that's such an understanding description of your MILs behaviour.

@Bergamotte that's such a sensible idea about involving the continence team
His partner is adamant that he is not constipated.
The frequency and what she feels is above normal " output" compound the problem.
I'm not convinced he's not a bit constipated.
I didn't think I was but taking magnesium has transformed my " output " and the feeling of incomplete evacuation.
I understand it draws water into the bowel.
And as common he's not drinking enough.

Trust me. He is constipated. There can be a hardened poo blockage higher up that allow some "new" soft poo to get through. Often these blockages interfere with the evacuation muscles and the situation gets compounded. He needs the GP or a massive Movicol dose to clear it. (Speaking from experience of late DF who also had dementia).

It's not necessarily that it is constipation. As AnnaMagnani suggests, his muscles might not be working so well.
I think ispaghula husk can be used to treat diarrhoea as well as constipation, and give something for his bowels to push along. Definitely check that with a medical professional though.

Drinking more water will be important, but good luck with that!

Could he be persuaded to wear disposable gloves that go straight into a bin beside the loo after use? I know it’s highly unlikely he would cooperate but would at least help with the mess until a proper solution is found.

Sorry, not meaning to disagree with slugsinthegarden - I was just slow at typing. Yes, overflow is also a possibility.

Has he had bloods taken by the GP? The itchy legs could indicate a vitamin deficiency so it seems worth asking for bloods just to rule this out.

You're all so kind and helpful.
His partner is so sure that he's not constipated. He was prescribed laxatives recently , his partner said they didn't help.
But maybe they weren't taken for long enough and I'm sure not as a large dose.
Faeces is his partner's nemesis so I think she would fear laxative effect .
I understand short term pain for long term.gain., but it's not me that's hands on .

@haggisaggis I am loving the idea of gloves , what a clever simple idea.
Will be suggesting this.

@Winter2020 he has had bloods.
Slightly anemic and slightly low in vit D .