DEMENTIA AND INCONTINENCE – Tips for caregivers

Caring for a loved one with dementia can be a challenging and emotional experience. As the disease progresses, many individuals with dementia may experience incontinence, which can be difficult for both the caregiver and the person with dementia. Incontinence can cause embarrassment, discomfort, and even skin irritation if not managed properly. As a caregiver, it's important to have a plan in place for managing incontinence and providing compassionate care for your loved one. In this blog, we'll discuss some tips and strategies for caregivers to help manage incontinence in individuals with dementia.

What is Incontinence ?

Incontinence is the involuntary loss of urine or feces. It is a common problem that can affect people of all ages, but it is more prevalent in older adults and those with certain medical conditions. The two main types of incontinence are urinary incontinence and fecal incontinence.

Urinary incontinence is the involuntary loss of urine. It can be caused by a variety of factors, including weak pelvic muscles, nerve damage, and prostate problems in men.

There are several types of urinary incontinence, including:

Stress incontinence: Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy.

Urge incontinence: You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night.

Overflow incontinence: You may feel like you can't fully empty your bladder, which can lead to frequent leaking.

Functional incontinence: Mental or physical problems such as dementia or arthritis prevent you from getting to the toilet in time.

Fecal incontinence is the involuntary loss of feces. It can be caused by a variety of factors, including nerve damage, muscle damage, and diarrhea. Fecal incontinence can be embarrassing and difficult to manage, but there are treatments available to help manage the condition.

Incontinence is the involuntary loss of urine or feces, and it can be caused by a variety of factors. The two main types of incontinence are urinary incontinence and fecal incontinence, and there are several subtypes within each category. Treatment options are available to help manage incontinence and improve quality of life.

Caring for a loved one with dementia can be a challenging and emotional experience. As the disease progresses, many individuals with dementia may experience incontinence, which can be difficult for both the caregiver and the person with dementia. Incontinence can cause embarrassment, discomfort, and even skin irritation if not managed properly. As a caregiver, it's important to have a plan in place for managing incontinence and providing compassionate care for your loved one. In this blog, we'll discuss some tips and strategies for caregivers to help manage incontinence in individuals with dementia.

 In What Stage of Dementia is Incontinence a problem?

During the middle stage of dementia, patients often experience disorientation, even in familiar settings, and may get confused while carrying out multi-step processes. For instance, a senior with Alzheimer's may forget the location of the bathroom in their own home, the purpose of the toilet, and the steps required for proper toileting. Consequently, they may fail to locate and reach the bathroom in time, struggle to remove and put on their clothes, and neglect personal hygiene. Toileting problems worsen throughout the middle stage of the disease, causing incontinence to progress from occasional accidents to a complete loss of bladder and bowel control in the late stages of Alzheimer's.

This makes patients dependent on others for their personal care, resulting in incontinence being one of the most challenging care issues for dementia caregivers. Seeking medical attention at the first sign of incontinence is crucial to rule out treatable causes such as UTI, medication side effects, or constipation. If no reversible cause is identified, implementing the following strategies may help manage toileting issues and incontinence at home.

 Incontinence Care Tips for Dementia

Dementia is a progressive disease that affects the brain, causing a decline in cognitive function and memory loss. One of the most challenging symptoms of dementia is incontinence, which can lead to embarrassment and discomfort for the individual and their caregivers. Managing incontinence in individuals with dementia requires patience, understanding, and a routine that helps prevent accidents.

To manage incontinence, caregivers should establish a routine that encourages the individual to use the bathroom at regular intervals. This routine can help prevent accidents and promote bladder and bowel control. Caregivers can also provide reminders by placing signs or notes in the bathroom to remind the individual how to use the toilet or when to go.

Incontinence products such as incontinence pads or adult diapers can help manage accidents and reduce embarrassment. Caregivers should ensure that the bathroom is easy to find and that there are grab bars or other aids to help with mobility. Wearing clothes that are easy to put on and remove can also help.

It's essential to seek medical attention at the first sign of incontinence to rule out any treatable causes of bladder/bowel control issues, such as a urinary tract infection (UTI), medication side effects, or constipation. Limiting fluids to prevent dehydration can lead to a UTI and increased incontinence. Therefore, it's crucial to maintain adequate hydration.

As the disease progresses, toileting problems may worsen, even with increased assistance and supervision. Late-stage dementia may result in a complete loss of bladder and bowel control, making patients completely dependent on others for their personal care. Caregivers must approach the issue with kindness and understanding, remembering that incontinence can be embarrassing and uncomfortable for the individual.

Here are some tips for caregivers of dementia patients to help manage incontinence:

Enhance the visibility and accessibility of the bathroom.
Establishing an accurate continence assessment is crucial to identify the type of incontinence a person is experiencing and to initiate an appropriate treatment plan. Even individuals with dementia may have a continence issue that is not related to their dementia but rather to another disease or the natural ageing process.

Opt for clothing that is adaptive.
In case buttons or zippers are hindering a patient's ability to take off their clothes and leading to accidents, it is advisable to purchase adaptive clothing  such as  pants that have elasticized waistbands or closures that are simpler to use, such as soft fastening or poppers.

Enhance the safety of the bathroom.
Seniors facing mobility challenges may struggle to reach the toilet on time due to their limited ability to move quickly. Moreover, as cognitive issues arise, they may also experience fears and uncertainties. It is recommended to make necessary additions or modifications to avoid any stressful or hazardous situations.

For instance, you can ensure that the bathroom has a nightlight, the floors are free of any hazards, and grab bars and/or toilet seat risers are installed to provide extra stability and reassurance while using the toilet. However, it is important to avoid any clutter or distractions in the room.

Enhance the commode's visibility.
To improve "aim," consider using a toilet bowl cleaner that colors the water or a toilet seat that illuminates the bowl. Adult males may feel more comfortable sitting while urinating to avoid any mess caused by low vision. It is recommended to remove any waste baskets or objects that a dementia patient may mistake for the commode.

Plan frequent visits to the bathroom
In case a dementia patient loses the ability to communicate and express their need to use the toilet, caregivers must take the initiative to schedule regular toileting breaks. Look out for non-verbal cues that may indicate the need to use the toilet. Encourage seniors to visit the bathroom after waking up, after meals, and before going to bed. Additionally, timed voiding throughout the day may help reduce accidents.

Offer verbal support during the toileting process.
Offer clear and concise prompts about the toileting process. Caregivers of dementia patients have also found success with creating instructional signs. Simple reminders with descriptive pictures to flush the toilet or wash hands may be beneficial for seniors who can still comprehend what they read.

Restrict available resources.
Frequent use of toilet paper or tissue due to obsessions can be challenging for caregivers and may cause plumbing issues. To minimize the need for toilet tissue, some caregivers restrict access to it or install an aftermarket bidet. The addition of a bidet nozzle or handheld bidet to an existing toilet can simplify personal care by spraying private areas to remove waste.

Older adults who are hesitant to wear incontinence products may find the latest advancements in incontinence supplies to be a pleasant surprise. Disposable briefs come in styles that resemble regular underpants and provide a comfortable fit with leak protection. Adequate absorbency is crucial in promoting personal hygiene and preserving skin integrity.

Substitute regular undergarments with incontinence briefs.
Older adults who are hesitant to use incontinence products may find the latest advancements in incontinence supplies to be a pleasant surprise. Disposable briefs come in styles that resemble regular underpants and provide a comfortable fit with leak protection. Adequate absorbency is crucial in promoting personal hygiene and preserving skin integrity.

Place absorbent pads on furniture and bedding.
To prevent soiling, cover the mattress with a waterproof cover. Oversized bed pads can safeguard bedding, furniture, and car seats. Incontinence pads are available in various sizes and can be either disposable or washable/reusable. If overnight accidents are a concern, consider placing a portable commode near the bed of a dementia patient for easier toileting.

Maintain dignity
Caring for incontinence demands patience, empathy, and a determination to respect the dignity of your loved one. Some family caregivers may refuse to provide incontinence care for their elderly parents. As dementia advances and total care becomes necessary, home care may not be sufficient to meet the extensive needs of the loved one. Entrusting dementia patients to skilled and devoted professionals guarantees that their requirements are met safely and appropriately.