Being the caregiver - even being involved in directing the caregiving plan - for a loved one with Alzheimer's disease or dementia can be demanding with respect to bladder and bowel control. But except in very late stages of the disease progression, symptoms are manageable. Like other facets of care for the patient diagnosed with Alzheimer's, facts need to be assembled and constantly assessed, there need to be strategies for establishing a routine, and the caregiver needs tactics for coping.
First of all, the symptoms of bladder and bowel control problems must be segregated from other causal factors. Medications, especially sedatives and antidepressants, can affect continence....and constipation. Dehydration can cause the urine to be more concentrated and irritating to the lining of the bladder, triggering urgency to urinate. Older people, especially women after menopause with the loss of natural estrogen, will experience more frequent urinary tract infections, symptoms of which can include frequency and burning when urinating.
Diverticulitis is prevalent in an estimated 50% of older women and can trigger urge fecal incontinence and bouts of diarrhea, necessitating adjustments in diet and the addition of fiber as a bulking agent. Men with an enlarged prostate or women with a prolapsed bladder can experience retention and incomplete emptying of the bladder due to blockage of urine flow.
If left untreated, this can lead to a permanently distended bladder in more severe situations, especially in men, and ultimately the need for a permanent, indwelling catheter or intermittent catheterization. Meanwhile, foods and beverages with caffeine, alcohol, and artificial sweeteners will have a diuretic effect and lead to frequency. Find all the culprits and remove or address as many as you can before suspecting a problem with bladder or bowel control per se. Sphincters, or the rings of muscles that help close off leakage from the bladder and rectum, may be just fine!
Emotional factors can come into play. Lack of privacy, particularly in a residential community, may cause the resident to be hesitant. Language may become a problem, with an inability to express the need to urinate or have a bowel movement. Problems can erupt from an older person feeling rushed by a caregiver, paid or volunteer.
There can also be environmental factors. The floor and toilet seat may be the same color, making it difficult to find the toilet. Orientation signs may be missing. The person with Alzheimer's disease may have trouble remembering how to undress or remove clothing to use the toilet. There is a virtual endless list of factors because variables in the environment continue to change. Assessment is not a single, one-time event but a continual watch.
To develop strategies, keep a record with a bladder diary, at least for several days, to ascertain patterns of when accidents occur and their frequency as well as trigger events. Seek to calm the individual when an accident does occur and offer assurances. Watch for nonverbal cues that the person with dementia is experiencing urgency, including restlessness or anxious facial expressions. Simplify clothing. Remove clutter or obstacles in the pathway to the toilet. Make sure the toilet is comfortable, a proper height, and navigable. Be attentive to the special cleansing and moisturizing requirements of aging, thinning skin, so vulnerable to rashes, fungi, and skin tears. Strive to establish a toileting routine, for both bladder and bowel management. It may require bladder retraining.