Helping your loved one meet their toilet needs

Why is it important to help your loved one meet their toilet needs?

People in their last weeks and days vary in the need to go to the toilet and family caregivers vary in how they feel about it. Helping your loved one can pose emotional and practical challenges, depending on their state of health, their personal hang-ups and the relationship between the two of you.

A common potential embarrassment is that for the first time in their life, your loved one will need to “wee” or “poo” in front of you and they may never have done this before, ever. In effect, they’re relinquishing control to you because they are too ill to keep control.

• As a family caregiver, you should aim to help to keep your loved one as clean and fresh as they would want to be. We don’t suppose you or they ever anticipated anything like this and you’ll be doing things they would do for themselves if they could. Doing them in a sensitive way will help minimise embarrassment for both of you
• It’s straightforward in terms of what needs to be done but to make it easier on both of you, we suggest that you draw on the knowledge, understanding and compassion you have for your loved one. Be brave but sensitive, preserve their dignity, and provide as much calm and privacy as the situation allows.
• Don’t rush what is needed – pace yourself because you’ll have to repeat it several times.

How to help your loved one meet their toilet needs

Some people feel it’s silly to be anxious about the poo which is natural and nothing to be ashamed of. The fact is, that if you have ever changed a child’s nappy it probably won’t be worse.

If your loved one wants or needs to go to the toilet

Let’s talk through what to do if they want to wee or poo. Let’s start by assuming they are mobile and can, perhaps with help, get to the bathroom using a walking frame or wheelchair. First, do some preparation:

• Line up the walking frame or wheelchair
• Get any volunteer help you’ll need
• Make sure you and your loved one have footwear with non-slip soles
• Check the bathroom, and the route to it, are well lit, uncluttered and dry underfoot
• Avoid sudden interruptions from outside the room by sliding the outside door sign to ‘Engaged’. If you’ll be in the bathroom with your loved one, shut the door when you get there
• Hoists are available at Cottage Hospice to help move your loved one to the bathroom. Ask one of the volunteers to show you how to use the hoist should you need it

Make sure the sink tap is running warm, and that you have:

• Towels
• Flushable wet wipes (optional)
• Toilet paper
• Your loved one’s favourite soap
• Clean pants or pads
• Any barrier creams used to protect your loved one’s skin
• Gloves and a plastic apron for you
• If you want, deodorising spray
• Disposable bags for any general and dirty waste.

What happens if they are on the toilet but find it hard to go?

Running water from the wash basin tap may help; if it doesn’t, check with one of the Hospice team, in case your loved one’s bladder isn’t able to expel urine. If constipation is stopping them from pooing, try gentle back massage. If that doesn’t help and it’s the right thing to do, the Hospice Team may prescribe medicine. Don’t rush your loved one once they start going; ask them to say when they’re finished. You’ll need to keep your loved one safe by staying beside them or just waiting beyond the curtain or door. Be prepared for what may be a long wait.

Cleaning when finished

Your loved one may be able to clean themselves using toilet paper and/or flushable wet wipes which is better for them and preserves their dignity. They may need to help or indeed be dependent on you to do it all, so put on apron and gloves, run some warm water and apply warm soap and water, repeating as necessary, drying carefully, perhaps applying barrier cream, if sore, and finally washing your own hands. It’s much easier to clean yourself after pooing than somebody else, simply because you’re not feeling what they’re feeling. Being gentle is very important and reassuring for your loved one

When your loved one can’t get to the bathroom?

Not that different. You simply prepare for everything to happen in or close to the bed. As well as the items listed above, you’ll need two bowls full of warm water for washing them. Even when they can’t get to the bathroom, your loved one may be able, with help, to get on and off a wheeled commode.

Your loved one may be fitted with a catheter to drain urine from their body through a tube and into a bag. If that is the case, a member of the Hospice Team will talk you through how to look after it.

When and how often to help your loved one meet their toilet needs

How do I know when they need to go to the toilet?

This is not easy and sometimes it’s hard to tell.

Your loved one’s tummy might be bloated or swollen by a tumour, by fluids, or by gas. So you can’t always see whether their bowels or bladder are full. The poo of people dying is extremely varied, from loose or runny to hard pellets; it may come painfully and slowly or explosively and unexpectedly. Knowing when they want to go helps keep calm and dignity.

While your loved one can speak, just ask them if they want to go to the toilet. In the early days, stick to how things were at home. If they went to the toilet after breakfast, for example, be ready for them to do the same now, particularly if their diet is unchanged, because their digestive pattern could be similar.

As death approaches, one’s body slows down and your loved one will poo and wee less. They will be less able to tell you what’s happening.  If that’s the case, you’ll want to look into the bed unobtrusively, say every couple of hours. If pads and bedding need changing, please look at the notes of guidance about moving your loved one.

Towards the end

As your loved one loses mobility and their body slows down, they will produce less and less waste. It may be best at that stage for your loved one to do their wee or poo ‘in the bed’. We can discuss this with you and help find the best solution.