How to prevent health issues that bedridden individuals commonly face

Whether due to illness, injury, or age-related conditions, being bedridden presents a unique set of health concerns. As caregivers, it is essential to understand and address the challenges our loved ones face to ensure their well-being, comfort, and dignity.

Learn more about the common health issues bedridden individuals experience, the steps you can take to prevent these health complications, and how to effectively deal with these challenges as they arise.

Here are some common health issues that bedridden individuals face, along with prevention tips and practical solutions to manage them.

Gastrointestinal and bladder issues

Prolonged bed rest can affect our bladder and bowel functions. Common gastrointestinal, bladder, and bowel issues that bedridden individuals face include gastric reflux, constipation, incontinence, urinary tract infection (UTI), and haemorrhoids.

Gastric reflux

When lying down, food is processed up to 66 per cent slower than a person in an upright position, which can result in increased acidity in the stomach. Furthermore, without the help of gravity to keep the acids down, these gastric secretions may collect at the top of the stomach and cause irritation. This is why bedridden individuals often experience symptoms like regurgitation and heartburn.

Solution: Raising the bed can prevent the occurrence of gastric reflux in bedridden individuals. Elevate the bed head by at least 15 to 20 centimetres. The higher the elevation, the better in preventing gastric reflux, but it is important to make sure that your loved one is still able to sleep comfortably. Adjustable beds are ideal for this purpose. Otherwise, a wedge pillow is equally effective for gastric reflux, but may cause neck discomfort for some.

Other ways to prevent gastric reflux include:

• Avoid eating before bed
• Avoid fatty foods that are hard to digest
• Avoid foods that stimulate acid production, such as coffee, caffeinated teas and soda, and orange juice

Constipation

Movement helps to regulate our digestive systems. Prolonged inactivity means peristalsis, a series of constrictions and relaxation in our intestines that creates a wave-like movement to push and break down food, which is affected, weakening bowel contractions. Furthermore, lying down reduces the help of gravity in exerting pressure on the anal sphincter, making it even harder to empty bowels.

Certain medications, such as blood pressure regulators and antidepressants, may also have side effects that can lead to constipation.

Solution: Ensure your loved one drinks plenty of water and has a diet high in fibre, and encourage movement and exercise where possible. Other ways to maintain optimal bowel function include:

• Setting a specific time each day for this, ideally 20-30 minutes after breakfast
• For hard stools, use a stool softener or bulk agent
• Lubricate the bowels using glycerine suppositories
• Gently massage the abdomen in a clockwise direction
• Only use laxatives and enemas under the order of a doctor or nurse

Incontinence

Incontinence is the loss of control over bladder or bowel movements, leading to involuntary leaks and accidents. It can happen for many reasons, including urinary tract infections (UTIs), constipation, weakening of the bladder or pelvic muscles, and nerve damage. Certain medications may also affect bladder control in the short term.

Toileting can be exceptionally tricky for bedridden individuals. Continence aids such as pads or catheters can help, but pose its own set of challenges as well. Friction from the pads may irritate the skin and catheters come with the risk of infections. Furthermore, the loss of independence can take a toll on emotional well-being and lead to feelings of shame and anxiety.

Solution: Ensure your loved one drinks plenty of water. This will help to dilute the urine and decrease bladder irritation. Avoid alcohol, coffee, citrus, and spicy food as they irritate the bladder and increase the need to urinate.

As a caregiver, you can encourage regular toileting, ideally every two to three hours. There are a few things you can do to make toileting easier for both of you:

• Keep a bedpan or portable commode close by
• Dress your loved one in clothes that are easy to remove
• Provide continence pads to help them avoid soiling the bed

After toileting, be thorough when helping them to clean up. Ensure that the skin is clean and dry to prevent further complications like pressure sores and infections. It is not always easy, but always try to remind yourself that a little patience and understanding go a long way in helping your loved one maintain dignity and self-respect.

There are several treatment options available to improve incontinence, such as pelvic floor exercises, biofeedback, electrical muscle stimulators, and more. Speak to your doctor to learn more about the options available for your loved one.

Urinary Tract Infection (UTI)

Without the help of gravity, the urge to urinate decreases even when the bladder is full. Even when a bedridden individual is aware of the urge to urinate, discomfort and embarrassment may result in them holding it in. This stagnant urine is a conducive environment for harmful bacteria growth.

Catheters often used to help with incontinence also increase the risk of UTI. Furthermore, a lack of movement can also lead to the development of kidney stones.

Solution: Ensure your loved one stays sufficiently hydrated to help flush out toxins and bacteria. Encourage regular toilet breaks. If your loved one is using a urinary catheter, make sure to change and clean it regularly to prevent infections.

Haemorrhoids

Being bed-bound and a lack of movement can result in increased pressure on the buttocks and reduce blood flow to the rectal area. Furthermore, strain from constipation also increases the pressure. These factors may cause veins around the anus and in the rectum to become swollen and inflamed, resulting in haemorrhoids.

Solution: To prevent the development of haemorrhoids, make sure your loved one takes plenty of water and fibre and has regular bowel movements.

If your loved one has already developed haemorrhoids, here are steps you can take to help treat it and prevent aggravation:

• Clean the anal area gently with pre-moistened tissues
• Apply zinc oxide or petroleum jelly to the affected area
• Apply cold compresses for up to 10 minutes several times a day to relieve itching

If bleeding from the haemorrhoid is heavy and dark in colour, persists for over a week, or happens for no reason, alert and consult a doctor.

Skin issues

Spending prolonged periods of time in bed often places pressure on specific parts of the body and leads to a buildup of dead skin cells, moisture, and bacteria, which can damage the skin.

Bed sores

Bed sores, also known as pressure ulcers, pressure sores, and decubitus ulcers, are damage to the skin caused by prolonged pressure or friction on certain areas of the body. This pressure prevents healthy blood flow to the area, leading to skin breakdown and painful sores.

Being bedridden places an individual at a higher risk of developing bed sores. The tailbone, hips, heels, and elbows are the most commonly affected areas. Bed sores typically show up as a colour change in unbroken skin and feel warmer than the area around it. In severe stages, the skin may begin to peel or become an open wound that reaches the muscle, tendon, and bone.

Solution: Bed sores take a long time to heal, so it's best to prevent them from developing in the first place. Here are some ways to help your loved one prevent bed sores:

• Keep the skin dry and clean: Clean urine stains thoroughly and use 100 per cent cotton sheets for better moisture absorption. Do not use plastic sheets as it causes perspiration and does not absorb moisture.
• Check the skin daily for signs of pressure sores, especially bony areas that are commonly affected, such as the tailbone, hips, and elbows. You can do this during bath time.
• Make sure your loved one has a nutritious diet and consumes sufficient vitamin C, zinc, and protein.
• Turn your loved one at least every two hours. Help them change positions and straighten out any wrinkles on the sheets.
• Consider using a ripple bed. An electrically operated one allows you to inflate different parts of the bed at different times to avoid placing pressure on a particular body part for too long. Alternatively, placing a spenco bed pad over the existing bed can also reduce pressure and friction.

If your loved one has started developing bed sores, alert the nurse or doctor immediately so they can begin treatment early. Treatment will vary depending on the severity of the bed sore. As a caregiver, here are some ways you can help:

• Always don disposable gloves before tending to bed sores to prevent infection.
• To take pressure off the bed sore, help your loved one change positions at least once every two hours and use pillows and foam pads that are at least one inch thick.

Rashes

Being on prolonged bed rest can cause sweat, moisture, dead skin cells, and bacteria to accumulate, and reduce airflow between your skin and clothing. This buildup can block sweat glands and lead to skin irritations and rashes. The use of continence pads also commonly leads to diaper rash because they trap moisture and bacteria against the skin.

Solution: Follow these guidelines to reduce the chances of your loved one developing a rash:

• Drink plenty of cold water helps to cool the body and relieve rash symptoms
• Light loose clothing reduces friction and improves temperature regulation
• Cotton clothing is more absorbent and better for ventilation 
• Avoid plastic sheets and waterproof mattresses as they do not absorb moisture well
• Keep the room cool and dry by ventilating the area and/or using dehumidifiers
• Ensure the room is kept at a cool but comfortable temperature

If your loved one uses continence pads, try to change pads frequently and as soon as they are wet or soiled. It is best to clean the area daily using a hypoallergenic cleanser. Dry the area thoroughly but be gentle when doing so. Pat the area dry or let it air dry rather than rubbing it which may thin and irritate the skin. Applying moisturiser before putting on pads can also help to reduce irritation and soothe inflamed skin.

Muscle atrophy and joint stiffness

As we go about our daily lives, we often take for granted the muscles we rely on to perform even the simplest tasks, like walking or reaching for objects. Being bedridden means that we are no longer able to engage these muscles and joints routinely, causing them to weaken and stiffen. Usually, muscles in the lower limbs that help us to stand upright are the first to go.

Immobility can also cause our joints and muscles to become stiff and inflexible. This is due to contracture, a condition where muscles, tendons, ligaments, or other tissues tighten and shorten, causing pain and further loss of movement.

Solution: Encourage your loved one to move, stretch, and exercise, if possible. Consult the medical team to find out what exercises your loved one can safely perform. Regular physiotherapy sessions can help to reduce the atrophy of target muscle groups, improve range of motion, and maintain joint flexibility. 

Do keep a close eye on your loved one as they perform these exercises. Stop the exercises if they experience pain and discomfort as it may indicate that they are doing the exercise wrongly or overexerting.

Depression

Being confined to the bed can take a toll on our mental well-being. The lack of engagement and environmental stimuli can lead to feelings of isolation, helplessness, and sadness. 

Solution: Actively engage with your loved one when you are present. Bring up interesting news or events to encourage active discussions, or entrust them with simple tasks that they can accomplish, such as coming up with a meal plan for themselves or learning new things online.

You can get other family members and friends involved too! Remind them to reach out frequently. Even a quick call from a loved one can make a huge difference for a person who is bed-bound. 

Sleep issues

Insomnia is common among bedridden individuals as they often have an irregular sleep schedule, are not getting enough exercise, feel restless, or are in pain from being in an uncomfortable position. Poor mental health also often causes sleep problems.

Solution: There are many remedies for insomnia. Try to establish a consistent sleep schedule for your loved one and help them stay physically and mentally active during the day. This could mean instead of afternoon naps, keep them engaged through passive or active exercises and discussions to stimulate their minds.

When it's time for bed, create a conducive sleeping environment that is dark and quiet, make sure they are in a comfortable position, and encourage the use of relaxation techniques like deep breathing.

Pneumonia

Limited mobility can lead to shallow breathing and mucus buildup in the chest and lungs, increasing the risk of pneumonia.

Solution: Help your loved one change positions frequently to aid in mucus drainage. Elevating the head of the bed during waking hours also reduces the chances of saliva or other liquids going down the wrong pipe.

Encourage your loved one to do exercises such as deep breathing, coughing, or actions that mimic blowing candles to improve lung function. Avoid overeating or bloating as it can make it difficult to breathe deeply.

Caring for a loved one who's bedridden is never easy. Besides compassion and patience, you need to understand the health condition your loved one faces and anticipate any complications that may develop and help to prevent them.

Remind yourself that every small effort counts in creating a more comfortable and supportive environment for your loved one. Whether it's helping with exercises, ensuring proper hygiene, or offering emotional support, your actions can make a meaningful difference in their well-being!

When the going gets tough, it is okay to take a break too. Caregiver stress is real. Don't hesitate to reach out for help if you need support.

ALSO READ: Caring for a bedridden loved one? Here's what to expect

This article was first published in Homage.