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