This particular topic is seldom featured in the literature on dementia, and I think it should be. It’s about toileting and hygiene and primarily about the ladies.

I worked as a home caregiver for a time, and in the beginning, one of the hardest aspects of care was the toileting of the person who could no longer do this for themselves. I’ve always been hypersensitive to smells, and I found this to be an especially challenging task with the women.

The first time I did it, I almost gagged but realized how important it was to give the person the dignity they deserved. I imagined the absolute bottom of my dignity and self-esteem would be when I became so incapacitated, I’d require someone else to wipe my privates after using the toilet. From then on, I made it a point that despite my issues with smell, I made toileting time as easy and normal an activity as possible.

However, this smell is not often discussed. Commonly senior women as they age, develop increased odor in the area of their privates, but with regular bathing, these areas get cleaned. With a person with dementia, bathing them can be problematic; they often refuse or balk. As a result, the family caregiver might bathe them every other day or schedule every two or three days in the week. In most elder care facilities, the resident is not usually showered every day either.

If dementia has progressed, the person generally sits much of the day and this can increase the risk of bacteria and odor in the area of the privates, especially with the women, and become a contributor to urinary infections (UTI)

What I incorporated into the toileting routine was a type of sitz bath while they were still on the toilet. I’d fill a small squirt bottle with warm water, and after they finished I’d wipe the first time, then I’d mini-shower their privates with the water and wipe again. It acts as a portable bidet and really gets everything down under clean.

It’s great to have an actual bidet, but usually, they are too low and don’t have the right seating for most elderly people, especially those with dementia. I suppose you might be able to rig up a potty chair over one. Although, I’ve never encountered this.

The bottle was portable and I’d take it on doctor visits or wherever there would be a probability the person would need to use the toilet.

In the beginning, they might be surprised. So, I’d explain, “This is your mini-shower, so you are super clean everywhere.” If they were capable, I’d let them do it.

This sitz bath made a significant improvement in their toileting hygiene, and I highly recommend incorporating this into your care routine.


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