Hi Bill, as an ex-nurse I can really relate to this "battle story"! One thing that springs to mind if that the gentleman may be experiencing faecal overflow as a result of constipation. Impaction can also result in outer anal sphincter being dilated. Is his medico is aware of this problem and underlying pathology been excluded?
David Harraway
OT
Melbourne Australia

Bill Maloney wrote:
I work in home health.  I have an elderly patient who c/o having to "wipe
and wipe" after having a bowel movement, but still doesn't obtain a level of
acceptable cleanliness.  He shared this problem tearfully, stating that in
just the past few years he feels as though he's "falling apart."  My
suggestions were as follows:  supplement his dry toilet paper with flushable
moist wipes; try to incorporate ample fiber (fruits and vegetables) in his
diet in an attempt to "firm up" the stool as much as possible; if
interested, obtain a bidet that attaches to the existing toilet (found one
at sammonspreston.com, anyone else have any other sources?).  Anyone have
any other ideas/suggestions/input?  I appreciate it.

Bill Maloney, OTR
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