Dealing with irritated buttocks on bedridden person
March 2, 2022 7:35 AM Subscribe
I am the primary caregiver for a mostly bedridden person. Part of that involves cleaning them up after a bowel movement, which presents a certain issue.
The bedridden person has a lot of bowel movements, which makes cleanup painful for them as the day goes on. Specifically, it becomes painful for them when their butt is wiped and cleaned. We're using alcohol free wet wipes. Any suggestions for making this less painful when there's 5-6 bowel movements a day?
Also, occasionally a small tear occurs at the top of the crack of the butt. Do I treat it with something, then cover? or leave free to air out?
The bedridden person has a lot of bowel movements, which makes cleanup painful for them as the day goes on. Specifically, it becomes painful for them when their butt is wiped and cleaned. We're using alcohol free wet wipes. Any suggestions for making this less painful when there's 5-6 bowel movements a day?
Also, occasionally a small tear occurs at the top of the crack of the butt. Do I treat it with something, then cover? or leave free to air out?
To add - the base of the back/top of the butt/sacrum area is one of the prime areas of concern for the start of a pressure sore because there’s skin right over bone, often without much padding, we lie/sit on it a lot, it gets cleaned and rubbed dry a lot, it gets sweaty. So you’re right to be keeping a close eye on this area and any nurse/other medical professional you mention it to, should understand your concern if you ask them for advice on something that in other circs might just look like a very minor injury.
posted by penguin pie at 7:54 AM on March 2, 2022 [4 favorites]
posted by penguin pie at 7:54 AM on March 2, 2022 [4 favorites]
Maybe a perineal lavage bottle with warm water first, then follow with a wipe? Might help wash off excess so less cumulative wiping throughout the day.
posted by helloimjennsco at 8:04 AM on March 2, 2022 [3 favorites]
posted by helloimjennsco at 8:04 AM on March 2, 2022 [3 favorites]
Are you using any kind of diaper cream? Many products function as a barrier cream- you apply it thickly, then you wipe over it (not removing any more of the cream than needed) and it protects the skin. Calmoseptine is a brand I’m familiar with.
Ultimately though, this is 100% a thing a wound, ostomy and continence trained nurse can help you with! They are also the experts in preventing pressure injuries, which is a serious risk for bedridden people. Ask your person’s primary care doctor about a wound care consult or clinic they can refer you to.
posted by MadamM at 8:13 AM on March 2, 2022 [5 favorites]
Ultimately though, this is 100% a thing a wound, ostomy and continence trained nurse can help you with! They are also the experts in preventing pressure injuries, which is a serious risk for bedridden people. Ask your person’s primary care doctor about a wound care consult or clinic they can refer you to.
posted by MadamM at 8:13 AM on March 2, 2022 [5 favorites]
You definitely need professional advice and eyes on the skin tears. If you are in the US, you can probably call this person's primary care physician and ask for a referral to home health care, if they aren't able to leave the house to see the doctor. The home health nurse or aide should be able to give you some more training on caring for this person's skin and continence needs as well.
For prevention, are you using a barrier cream after you clean up? Barrier cream both calms irritation that's already there and creates a protective layer to help prevent irritation from urine/feces/chafing. Instead of using regular wet wipes, use adult-size wet wipes with vitamin E, aloe, or another skin conditioner. They also make special peri-area cleansers that you can use to clean gently but thoroughly, so you don't have to wipe as much. You use those with adult-sized disposable washcloths. Use briefs with the highest level of absorbancy to keep them as dry as possible when they do have a bowel movement.
Here's a link that describes some of the products you can use and how to use them.
posted by assenav at 8:25 AM on March 2, 2022 [5 favorites]
For prevention, are you using a barrier cream after you clean up? Barrier cream both calms irritation that's already there and creates a protective layer to help prevent irritation from urine/feces/chafing. Instead of using regular wet wipes, use adult-size wet wipes with vitamin E, aloe, or another skin conditioner. They also make special peri-area cleansers that you can use to clean gently but thoroughly, so you don't have to wipe as much. You use those with adult-sized disposable washcloths. Use briefs with the highest level of absorbancy to keep them as dry as possible when they do have a bowel movement.
Here's a link that describes some of the products you can use and how to use them.
posted by assenav at 8:25 AM on March 2, 2022 [5 favorites]
is there no way they can be helped up to use a bedside commode?
What we did in a similar circumstance was, the patient was able to get to the bedside commode - it was close enough to the edge of the bed that they'd sort of swing onto it. The commode was lined with a plastic bag. (I am aware there were environmental problems with this; this procedure would have had to be optimized better for the long term.) Anyway, patient would poop and then clean up with very-wet paper towels of the soft Viva variety, which had been prepared in advance. (I now see that disposable washcloths such as those linked above are a thing, and surely better.) Once clean, he'd use a soft rag to dry. The dirty paper towels would also go into the bag-lined commode bowl.
When he was done and back in bed, caretake would dispose of entire bag containing poop and used paper towels.
I hope you can find a way to use water instead of those wipes. In my experience the wipes are extremely irritating to delicate skin if used as a primary cleaning method. I never used them on my babies for this reason.
ETA: even rinsing the wipes out with clean water before using them is an improvement.
posted by fingersandtoes at 9:02 AM on March 2, 2022 [3 favorites]
What we did in a similar circumstance was, the patient was able to get to the bedside commode - it was close enough to the edge of the bed that they'd sort of swing onto it. The commode was lined with a plastic bag. (I am aware there were environmental problems with this; this procedure would have had to be optimized better for the long term.) Anyway, patient would poop and then clean up with very-wet paper towels of the soft Viva variety, which had been prepared in advance. (I now see that disposable washcloths such as those linked above are a thing, and surely better.) Once clean, he'd use a soft rag to dry. The dirty paper towels would also go into the bag-lined commode bowl.
When he was done and back in bed, caretake would dispose of entire bag containing poop and used paper towels.
I hope you can find a way to use water instead of those wipes. In my experience the wipes are extremely irritating to delicate skin if used as a primary cleaning method. I never used them on my babies for this reason.
ETA: even rinsing the wipes out with clean water before using them is an improvement.
posted by fingersandtoes at 9:02 AM on March 2, 2022 [3 favorites]
From my own experience, the context different, I can say that anything out of the ordinary down south can become chronic before you know it.
I had a suspected covid infection last year September, accompanied by some exciting gastric disturbance. The result, what I thought were haemerhoids was in fact an anal fissure, a very small tear, but very strategically placed. In most active people, with the right meds, this usually can heal within weeks, instead it became chronic, and 6 months later, post surgery, I think I'm eventually healing. I'm a daily cyclist, so being off the bike has been very frustrating.
So a very different context, and your challenge is much greater, but the past 6 months has had me realise how sensitive and important that part of your body is. Frequent aggressive wiping is a no no. Dabbing is much better. Even using a moist wipe or cleaning with a bidet has its risks. Dab dry to avoid fungal infections. The other thing to realise is that as much as you want to keep clean, there are beneficial microbes there, messing with the balance is not a good idea (my doctor recommended bidet cleaning only once a day or so).
So in short, listen to the other posters here and get expert advice. It's amazing how much pain that tiny cut can cause.
posted by BrStekker at 10:29 AM on March 2, 2022 [1 favorite]
I had a suspected covid infection last year September, accompanied by some exciting gastric disturbance. The result, what I thought were haemerhoids was in fact an anal fissure, a very small tear, but very strategically placed. In most active people, with the right meds, this usually can heal within weeks, instead it became chronic, and 6 months later, post surgery, I think I'm eventually healing. I'm a daily cyclist, so being off the bike has been very frustrating.
So a very different context, and your challenge is much greater, but the past 6 months has had me realise how sensitive and important that part of your body is. Frequent aggressive wiping is a no no. Dabbing is much better. Even using a moist wipe or cleaning with a bidet has its risks. Dab dry to avoid fungal infections. The other thing to realise is that as much as you want to keep clean, there are beneficial microbes there, messing with the balance is not a good idea (my doctor recommended bidet cleaning only once a day or so).
So in short, listen to the other posters here and get expert advice. It's amazing how much pain that tiny cut can cause.
posted by BrStekker at 10:29 AM on March 2, 2022 [1 favorite]
+1 on home health care and on barrier cream. Agree with getting professional help and guidance on the wound care. Infection can start up before you know it.
Also, have you considered an alternating pressure mattress? Worked very well and very fast to clear up sores on our bedridden loved one.
A home health worker can review your supplies and care techniques. That really helped us.
posted by rw at 10:46 AM on March 2, 2022 [3 favorites]
Also, have you considered an alternating pressure mattress? Worked very well and very fast to clear up sores on our bedridden loved one.
A home health worker can review your supplies and care techniques. That really helped us.
posted by rw at 10:46 AM on March 2, 2022 [3 favorites]
A dab of petroleum jelly on the anus makes the next cleanup easier and helps reduce tearing. This will reduce the discomfort and irritation caused by cleanup. or diaper creme.
posted by theora55 at 10:47 AM on March 2, 2022 [2 favorites]
posted by theora55 at 10:47 AM on March 2, 2022 [2 favorites]
Can you call her doctor and ask advice? Her doctor will definitely want to prevent infection and a pressure sore. Also, is the frequent bowel movement issue part of the illness or the patient's baseline toileting habit? If part of the illness perhaps the doctor can suggest a way to reduce BM frequency. Staying on the bedpan less frequently and for a shorter duration of time can both help.
Ask also about ways to prevent bedsores, such as special pads which can be purchased or, if a mattress, rented from a durable medical equipment (DME) company. The doctor might suggest a bandage-type product that covers the skin tears that stays in place and helps prevent worsening. I'm thinking of Tegaderm, which is a clear film, but there are probably better products.
One tip nurses use with hospital patients who need the bedpan frequently is to powder the hell out of the rim of the bedpan and the patient's bottom and coccyx area to make the plastic more slippery. Tears occur where there is friction, and this is a simple tip. Cleaning her bottom and anal area with baby wipes, the softer the better, is much better than toilet tissue, especially dry toilet tissue.
Alternatively calling her insurer (if the patient does not have straight Medicare) and speaking with a nurse might offer some assistance. There might be a wound-care nurse on call that you can speak with.
posted by citygirl at 11:21 AM on March 2, 2022 [2 favorites]
Ask also about ways to prevent bedsores, such as special pads which can be purchased or, if a mattress, rented from a durable medical equipment (DME) company. The doctor might suggest a bandage-type product that covers the skin tears that stays in place and helps prevent worsening. I'm thinking of Tegaderm, which is a clear film, but there are probably better products.
One tip nurses use with hospital patients who need the bedpan frequently is to powder the hell out of the rim of the bedpan and the patient's bottom and coccyx area to make the plastic more slippery. Tears occur where there is friction, and this is a simple tip. Cleaning her bottom and anal area with baby wipes, the softer the better, is much better than toilet tissue, especially dry toilet tissue.
Alternatively calling her insurer (if the patient does not have straight Medicare) and speaking with a nurse might offer some assistance. There might be a wound-care nurse on call that you can speak with.
posted by citygirl at 11:21 AM on March 2, 2022 [2 favorites]
5-6 bowel movements per day, is a lot. Maybe this person needs a diet change, and less stool softeners if that is a medication they take. Cut the stool softeners in half, make dinner at 5:00 PM, and leave a fasting window from 5PM until 8 or 9 AM. This gives time for the gut to rest, and maybe with decreased stimulation from poop meds the out put will decrease in volume, and number. Normal bowel function is the three and three "rule". Normal is three a day, to three per week. 5-6 per day is too much of something, meds, water, food, or irritating undigested food. Getting people up to toilet is good for them, it helps with gravity flow for urine, and gravity flow for fecal matter. Walking is the most normal exercise for us. Encourage ambulation so that everything comes out once to three times per day. Moisture barrier creams are good, but if there is an infected fissure, that is going to take washing rather than wiping, patting dry, antibiotic ointment at just the irritated site, then moisture barrier over the area. If this person is in diapers, make sure they are absorbent ones, without plastic exteriors to cut down on urinary tract infections which go along with this situation. Willow brand diapers are expensive but airy, and effective.
Home care is mandated for pressure ulcers, wound care, and bathing. Best to you and the person you are caring for.
posted by Oyéah at 12:03 PM on March 2, 2022 [2 favorites]
Home care is mandated for pressure ulcers, wound care, and bathing. Best to you and the person you are caring for.
posted by Oyéah at 12:03 PM on March 2, 2022 [2 favorites]
Response by poster: Mild update: We have an alternating pressure mattress on an in-home hospital bed and are using the barrier cream that was used on them in the hospital. For now, getting up and using even a bedside commode is a non-starter due to the general illness. Sitting up on the edge of the bed for three times a day for 15 minutes is the current goal for now, and steadily increasing the time and number of times is a long term goal. So a bidet (which we do have in the bathroom) is out for a while.
They're allergic to petroleum products.
The number of bowel movements is prescribed at the moment, and a good thing.
Will talk to insurance about home health care nurse that can visit maybe once or twice a week.
Thank you.
posted by clocksock at 4:45 PM on March 2, 2022 [1 favorite]
They're allergic to petroleum products.
The number of bowel movements is prescribed at the moment, and a good thing.
Will talk to insurance about home health care nurse that can visit maybe once or twice a week.
Thank you.
posted by clocksock at 4:45 PM on March 2, 2022 [1 favorite]
If you can combine sitting on the side of the bed with bedpan use that might help. Evacuating one's bowels in a semi-sitting position is not ideal, and actually puts pressure on thin-skinned bony prominences of the lower back that are not usually subject to pressure. An alternating pressure mattress would probably make this maneuver easier. Having a step or surface she can brace her feet against while sitting makes using the bedpan or commode much more natural, helps her sense of security while sitting, and assists with muscle use while defecating.
I think a home care nurse for skin tears or potential bedsores is a good idea. It sounds like you are doing a great job caring for this person. A great skin cream is called Udderly Smooth (an awful name, and the tube is printed to look like cow skin) but it is a wonderful, healing cream. Also widely available and cheap. I used to hand it out to transplant patients taking a certain medication that could cause nasty skin rashes that could cause them to stop treatment. It worked well. Hope this is helpful.
posted by citygirl at 5:09 PM on March 2, 2022
I think a home care nurse for skin tears or potential bedsores is a good idea. It sounds like you are doing a great job caring for this person. A great skin cream is called Udderly Smooth (an awful name, and the tube is printed to look like cow skin) but it is a wonderful, healing cream. Also widely available and cheap. I used to hand it out to transplant patients taking a certain medication that could cause nasty skin rashes that could cause them to stop treatment. It worked well. Hope this is helpful.
posted by citygirl at 5:09 PM on March 2, 2022
I would not suspect it's a "tear". It's an irritation. Ordinary barrier cream, like Desitin should help. It's an irritation caused by feces. I'm incontinent, this way, and have the problem from time to time. It's like my crack is trying to go deeper. Some heavier people get more serious infections in that area.
Another help is how you clean. I use a spray called "Peri-wash". Life improved since I discovered this product! For cleaning skin or even wiping up surfaces that might get dirty.
Another issue is about what the person wears. If it is too snug in the crotch, anything fecal is driven UP the backside. THIS is what causes that fissure.
posted by Goofyy at 6:57 AM on March 3, 2022
Another help is how you clean. I use a spray called "Peri-wash". Life improved since I discovered this product! For cleaning skin or even wiping up surfaces that might get dirty.
Another issue is about what the person wears. If it is too snug in the crotch, anything fecal is driven UP the backside. THIS is what causes that fissure.
posted by Goofyy at 6:57 AM on March 3, 2022
Sounds like they may be on lactulous? There’s a product called skin prep that we sorta cheat with, it helps skin to not tear when you take bandages off, you could try that on clean dry skin although I’d do an allergy patch test first. You can also get hydrocolloid bandages specifically made for the sacrum but I gotta be honest, that’s a very common area for skin breakdown and hard to heal with ongoing frequent bum’s. (There’s a lot of acid/bile stuff in poop on top of the rubbing) if the stool is like LIQUID you could ask if they’ll do a rectal tube but honestly I’m not sure that’s a home health sorta intervention or not.
posted by yodelingisfun at 10:32 PM on March 4, 2022
posted by yodelingisfun at 10:32 PM on March 4, 2022
This thread is closed to new comments.
In my care assistanting days, Sudocrem was the main thing we used to try and make the skin in this area more comfortable, so you could try that if you’re not already (for the general soreness rather than the tear).
Best of luck.
posted by penguin pie at 7:49 AM on March 2, 2022 [13 favorites]