5 Steps to Managing Urinary Incontinence in Alzheimer's

Health Professional

Urinary incontinence is a distressing but very common problem in people with mid to late-stage Alzheimer's disease. There are lots of things you can do to help.

1st-Exclude diseases and conditions that could be causing urinary incontinence

Remember, people with Alzheimer's can get sick too. Urinary incontinence may just be a symptom of an underlying health problem so will require evaluation by a doctor followed by appropriate treatment. This may cure it. Examples of symptoms that require medical investigation include;

  • blood in urine.
  • prostate problems in men.
  • offensive smelling urine (could be a urine infection, dehydration, diabetes or other kidney problem).
  • weight loss could be a sign of other serious diseases.
  • severe constipation.
  • pain when passing urine, back pain, any pain (for instance headaches could be due to kidney failure).
  • Prescribed drugs can have side effects that affect continence.

2nd-Urinary incontinence can be multi causational

Urinary incontinence in people with Alzheimer's is sometimes due to a combination of factors. Once you have excluded disease as a cause of their incontinence think about:

  • improving effective communication to try to limit the impact of confusion caused by Alzheimer's disease.
  • room layout and easy bathroom access. Good lighting is important. Big mirrors can confuse someone with Alzheimer's. A bright or distinct toilet seat may help to direct the person to the right place.
  • is the 'patient' able to call for assistance?
  • minimize physical problems caused by limited mobility and exercise, long periods of bed care. This could include use of walking aids, more exercise, effective pain control and others you identify.
  • bad diet and amount of fluid intake will also affect toilet programs and incontinence.
  • poor clothing choices can inhibit their ability to use the bathroom.

3rd-Incontinence Treatment Program Rules for People with Alzheimer's

A toileting program is not difficult but there are some rules that will help make it more successful.

  • be consistent and keep to as rigid a timetable as is practicable.
  • always take them to the bathroom if they request to go.
  • factor in any regular toilet trips you have previously established in their routine that give good results.
  • never shout or hurry them. Talk to them with respect. Be reassuring.
  • allow privacy whenever possible.
  • help minimise confusion during bathroom trips.
  • orientate people with Alzheimer's. So for example say,"Dad I'm taking you to the bathroom/ restroom / lavatory (whatever is most familiar to the person). "Mrs Jones we are at in the bathroom/ washroom / etc now, try to go".
  • do not expect a result (voiding) on each visit and do not keep them in the bathroom or on the toilet too long.

4th-Begin Incontinence Treatment Program

Begin your timed toilet trips every 2 hours. (This does seem quite a lot butthis can be changed over time once you establish the best toileting program for that individual.)

  • factor in bathroom trips before and after meals, and just prior to bedtime.Night toileting should be maintained on a regular time basis too, but it is more practical to decrease the bathroom visits to every 4 hours.
  • praise any positive results.

5th_ And Finally

Reassure the person that their behavior is appropriate. Talk with a soft reassuring tone. Remember that some people with dementia may require frequent redirection. Use brief statements.

Fluid intake is important. It should be about 1.5 litres each day (unless a doctor advises you otherwise). Decrease fluid intake before bedtime. It is important to maintain a healthy bowel and digestive system.

After a few weeks you can begin to decrease toilet trips if 2 hourly is too often. Introduce any changes very gradually, one change at a time is best to evaluate success.

If you have any problems consult a doctor or nurse specializing in incontinence problems.

More information on urinary incontinence here at HealthCentral

Information about Fecal Incontinence and Alzheimer's