Alzheimer’s and Incontinence

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Day to day caregiving is difficult enough. However when dealing with Alzheimer’s, the very nature of this disease and the way it affects the brain frequently have added frustrations and difficulties, which make Caregiver’s lives just that much more difficult. Our mission at www.easycaregiving.com is to make sure you have every advantage possible. Please join me at that site and sign up for a FREE newsletter and received a FREE stress management guided imagery recording.

Today, part two of our series, we are going to talk about incontinence. The primary source for the following is great booklet from my library called “Understanding Difficult Behaviors: Some Practical Suggestions for Coping with Alzheimer’s Disease and Related Illnesses”. It was written 20 years ago but has stood the test time, as one of the best resources for Alzheimer’s. It was first published by the Geriatric Education Center of Michigan.

INCONTINENCE

The first thing we should say is, it is not necessarily permanent. Except in the very late stages, it is controllable. It’s just a matter of how much time and effort you have to put into helping your loved one become autonomous when it comes to going to the bathroom. Remember there are different levels of incontinence. For example, a person may have bladder incontinence, or bowel incontinence, it could be only night time incontinence. Let’s take a look

Possible Causes are physiological, medical, and environmental.

Here’s a very long list of causes:

  • Infections, such as urinary tract infection (UTI) urethritis or vaginitis, can cause loss of urine control.
  • Men are especially susceptible to infections after prostate surgery.
  • Prostrate problems in men can cause retention of urine
  • In women, constipation or fecal impaction can block the bladder so that urine leaks past the blockage.
  • In older women, weak pelvic muscles can sometimes cause “stress incontinence” or “leaking” This may happen when a person laughs, coughs, or sneezes.
  • Chronic illnesses such as diabetes, Parkinson’s disease, strokes or any other condition which limits mobility and/or causes chronic pan (e.g., rheumatoid arthritis) can make it difficult to get to the bathroom.
  • Vision changes can make it difficult to see the way to the bathroom or the bathroom door properly.
  • Insufficient intake of fluids can cause irritation of the bladder.
  • Dehydration may cause incontinence by lowering or eliminating the signal to urinate.
  • The urge or signal to go to the toilet may no longer be understood or received by the brain (due to brain changes due to dementia).
  • Fluids having a diuretic effect, such as coffee, tea, cocoa, beer, colas, can affect control of urine.
  • Medications, especially tranquilizers, sedatives and antidepressants can affect incontinence. These are often given to facilitate sleep or calm behavior but these drugs can also affect bladder muscle function and/or reduce a person’s sensitivity to body signals. Diuretic medications such as Lasix can also increase frequency of urination.

ENVIRONMENTAL CAUSES

  • Distance to the bathroom may be too far.
  • Bed may be too high from the floor, making it difficult for the person to get up.
  • Floor and toilet seat may be the same color, making it difficult to find the toilet.
  • Improper footwear may cause person to be afraid of falling.
  • Persons may have trouble undressing to go to the toilet.
  • Lack of privacy, particularly in institutional settings, may inhibit the person.
  • Poor lighting may make it difficult to find the bathroom or to locate the toilet inside the bathroom.
  • Orientation cues (signs) may be lacking which could help the person locate the bathroom.
  • In nursing homes, being in bed with rails, being restrained or lying on protective pads may give residents the message that they are expected to be incontinent.

OTHER CAUSES

  • Person may not remember what to do once in the bathroom.
  • The task may be too complicated.
  • Person may need help undressing, sitting on the toilet, wiping or rising from the toilet.
  • Person may be fearful or anxious about having to partially undress in front of an unfamiliar caregiver.
  • Caregiver may not be giving simple or clear enough instructions.
  • Caregiver may be rushing.
  • The person may no longer be able express need to urinate.

COPING STRATEGIES

If you really want to help, observe carefully and assess the problem.

  • Do accidents happen only at certain times of the day or only at night?
  • How often does the person urinate?
  • Did the incontinence begin suddenly?
  • Is the person urinating in improper places, such as in flower pots or in closets or in the kitchen sink?
  • Do accidents happen on the way to the bathroom?
  • Keep a diary or a log for several days noting times when accidents occur and the amount of fluid intake and output. The information will give you clues and also be helpful to the doctor.
  • Have a through medical examination to discover any possible infections or medication problems that may be contributing to the incontinence.
  • If a person has a fever that persists for more than 24 hours, report it to the doctor at once. Urinary tract infections are often accompanied by fevers and can be dangerous if left untreated.
  • Be aware that a number of medications can be used to treat incontinence. However, these drugs may cause side effects such as dry mouth and eye problems and therefore must be carefully monitored.
  • If a diuretic is being taken, it is important to carefully consider the times of day when it is given.
  • Consider a continence diagnostic evaluation if the cause of the incontinence is still unknown. This would involve a series of tests that can determine how well the urinary system is functioning. These procedures are, however, uncomfortable and expensive and the benefits need to be carefully evaluated on an individual basis.
  • Be sure the person is drinking adequate fluids – a minimum of 5 – 8 glasses daily. Many dementia victims forget to drink or may no longer recognize the sensation of thirst. A wide variety of substances act as fluids, e.g., jello, popsicles, ice cream. Also, try herbal teas and decaffeinated coffee; caffeine can affect continence adversely.
  • Set up a regular schedule with specific times for the persons to have something to drink, e.g., with meals and three daily snacks.
  • Observe toileting pattern of the person both during the day and at night. Try and toilet just before his/her expected time. This may vary from every two to four hours.
  • Remember to toilet them before and after meals and immediately before going to bed.
  • Make sure the person actually urinates before getting off the toilet.

VERY IMPORTANT

  • Communicating with some one that has Alzheimer’s takes a conscious effort: When trying to direct someone simplify the steps involved. Do one step at a time.
  • Use short words and short, simple instructions. For example: “Sit down.”
  • Watch for nonverbal clues that the person with dementia has to go to the bathroom, such as reaching for a belt, tugging at a zipper or taking pants down. Also watch for restless behavior or facial expressions that may signal distress.
  • Make sure that sitters, nursing home staff or other paid caregivers understand the terms or words that are familiar. Some people may use children’s words or slang like “pee” “tinkle” or “take a leak”. Make sure that the Alzheimer’s sufferer knows the words they are using.
  • Listen carefully, because the person may say the wrong word. For example “I want tea” or “take a peek”
  • Even severely impaired people do care when they have had an accident. Saying something like “Soon, everything will be all right” or “Don’t worry, everything will be fine” may reassure the person.

CLOTHING

  • Simplify clothing. Try Velcro tape instead of zippers or buttons.
  • Try elastic waistbands for trousers or wrap around skirts.
  • Use underpants when possible. They can serve as a reminder to stay dry and as a stimulus to use toilet when wet.
  • Change clothes when they are wet. Try not to let the person become accustomed to wet clothes.
  • Select clothing that is washable and does not need ironing. Tennis shoes may be easier to keep clean if person is incontinent.

PROTECTIVE GARMENTS

  • Adult briefs, are sold small, medium, large and extra large. Make sure you get the right size. A little too small an they may pinch or be uncomfortable, too large and they will not be leak proof and fall down when wet.
  • Washable briefs are available with snapping plastic outer layer. Disposable briefs are bit pricey.
  • Washable pants with disposable pads are and alternative for urinary incontinence only.

SKIN CARE

  • Wash the skin after any accident. It is important to keep the person’s skin clean and dry to prevent rashes and sores. There are special products available which act as both soaps and skin conditioners. Look into creams for adult diaper rash.

AT NIGHT

  • Consider putting a commode beside the bed, especially if the person has trouble moving around.
  • Make sure there are night lights in the bathroom, hallway and bedroom.
  • Make sure there is no clutter or obstacles in the pathway to the toilet. Falls often occur on the way to the bathroom at night.
  • Make sure footwear is not floppy or slippery.
  • Use disposable pads and rubberized flannel sheets to protect bedding.

BATHROOM AIDS:

  • A raised toilet seat with grab bars makes it easier for a person to get on and off the toilet.
  • Make sure the seat is fastened securely to the toilet so that it does not slip when a person sits on it.
  • Padded toilet seats are more comfortable for the person who must sit for some time.
  • If getting to the toilet is a problem, place a chair style commode near the bed. Make sure you leave the top off at night.
  • Grab bars attached to the toilet seat are wall-mounted.

OTHER CONSIDERATIONS

  • Purchase washable chair cushion covers.
  • Soiled clothing hidden in a closet, under the bed or in a dresser drawer may be signs of incontinence.
  • It is very important to respect the privacy and dignity of the person who may be having problems with incontinence. Losing control can be a terribly humiliating and embarrassing experience and caregivers need to be sensitive to these feelings. Every effort should be made to preserve the person’s self-esteem, for many dementia victims are quite aware of their deficits.
  • Family member s and other caregivers also may feel embarrassed to awkward when assisting with toileting and should be aware that these are normal feelings Sometimes people find cleaning up to be a very difficult and unpleasant task and may gag. Try to be calm and reassuring and recognize that both of you probably feel quite uncomfortable.
  • It goes without saying, put lids on waste paper baskets and other trash containers.

Wow, that is big topic. Again, like the previous topic “anger and agitated behavior”, we are only scratching the surface of possible causes and solutions. But I sincerely hope you will help me by signing up for my newsletter at www.easycaregiving.com

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