5 Steps to Managing Urinary Incontinence in Alzheimer's
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.
Information about Fecal Incontinence and Alzheimer’s
Christine Kennard wrote about Alzheimer’s for HealthCentral. She has many years of experience in private and public sector nursing care homes for people with dementia. She has worked in a variety of hospital, public and private health settings and specialized in community nursing. Christine is qualified in group analytic psychotherapy, is registered in general and mental health nursing and has a Masters degree.