Just the Facts and More: Incontinence

Incontinence, which includes loss of bladder and/or bowel control and bedwetting, is a difficult problem if you are caring for an Alzheimer patient. Incontinence is common among Alzheimer patients -- especially those in the latter stages of the disease.

Although you can manage incontinence by changing the patient's routine, clothing or environment, at some point you will need to accept incontinence as a permanent condition of the disease.

If incontinence is a new behavior, your first and most important step is to identify the possible reasons for this loss of control. Ask yourself the following questions:

Medical Conditions

  • Could the reason be medical? For example, could the person have a urinary tract infection, constipation, or a prostate problem?
  • Is there an illness such as diabetes, stroke, or Parkinson's disease?
  • Do movement difficulties make it hard for the patient to get to the bathroom in time?
  • If the answer to any of these questions is "yes," you may want to consult with your physician.

Stress

  • Is the incontinence caused by stress or movement? For example, does the person release urine with a sneeze, cough or laugh?
  • Does fear of an embarrassing accident make the person want to continually visit the bathroom?
  • Keep in mind weak pelvic muscles in a woman could cause uncontrollable loss of urine.

Medication

  • Is the person on medication that might intensify the behavior?
  • Is it possible that tranquilizers, sedatives, or diuretics contribute to incontinence? Keep in mind, for example, that some tranquilizers can relax the bladder muscles.
  • Medications used to treat incontinence can cause such side effects as dry mouth and eye problems.

Dehydration

  • Did you withhold fluids when the person started to lose bladder control? If so, the person might become dehydrated. Dehydration can, in turn, create a urinary tract infection which can lead to incontinence.

Diuretics

  • Are you giving the person fluids that might produce a diuretic effect (increased urination)? Beverages such as coffee, colas, and tea might contribute to incontinence.

Environment

  • Is it possible that the person can't find the bathroom?
  • Does the person have too far to travel to reach the bathroom in time?
  • Is the person afraid of falling?
  • Are there obstacles in the path such as chairs or throw rugs?
  • Is the path well lit?

Clothing

  • Does the person have problems undressing in the bathroom?
  • Are the zippers and buttons on clothing causing problems?

Action Steps

Innovate.

  • Be willing to experiment with new concepts and ideas. Keep in mind that every person is different. What works for one person may not work for another.

Understand.

  • Remember that accidents are embarrassing. Be matter-of-fact and understanding and avoid blaming or scolding the individual.
  • When the person is successful, use praise, encouragement and reassurance.

Communicate.

  • Encourage the person to tell you when (s)he thinks (s)he needs to use the bathroom. The person may not be able to say, "I need to use the bathroom."
  • Watch for visible cues that the person needs to use the bathroom. For example, the person may get restless, make unusual sounds or faces, or pace around the room.

Plan ahead.

  • Train yourself to respond to the person's routine and schedule. Identify when accidents occur and plan ahead.
  • If an accident happens every two hours, you will need to get the person to the bathroom before that time.
  • You might also find it helpful to keep a notebook or log that notes when the person uses the bathroom.

Change and adjust.

  • Be patient and allow the person adequate time in the bathroom.
  • In addition, rearrange the environment to make it easier for the person to use the bathroom. For example, leave on a nightlight in the bathroom and bedroom.
  • Put a picture of a toilet on the bathroom door, or paint the bathroom door a color different than the wall.
  • If accidents occur at night, consider a portable commode or urinal near the bed.

Simplify clothing.

  • Keep the person's dress simple and practical. Instead of choosing clothing with zippers and buttons, choose easy-to-remove and easy-to-clean styles such as sweat pants with elastic waistbands.
  • Consider using such products as pads or protective bedding, adult diapers, or panty liners for female patients.

Follow-up.

  • Make sure the person uses the bathroom. You may need to assist in removing clothes, wiping or flushing.
  • You might also want to stimulate urination by giving the person a drink of water or running water in the sink.
  • Keep sensitive skin areas clean with regular washing and application of powder or ointment.

Control.

  • To help control night incontinence, limit the person's intake of liquids after dinner and in the evening, and cut down on drinks such as cola, coffee, tea, and grapefruit juice.
  • Encourage the person to drink at least one-and-a-half quarts (six cups) of fluids daily. For variety, you might want to introduce decaffeinated herbal teas, decaffeinated coffee, Jell-O or fruit juice.
Help the person with Alzheimer's retain a sense of dignity despite the problems with incontinence. Reassuring and nonjudgmental statements will help lessen feelings of embarrassment.


Resources

One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.

The primary resource for this fact sheet was Mary Barringer, RNC, Partner, Professional Care Management Services, Springfield, Illinois.

Special thanks to the following Chapters of the Alzheimer's Association: Orange County, Honolulu, Greater Washington, DC, Massachusetts, Cleveland, South Central Michigan.

Other Resources include:
  • Miriam K. Aronson, Ed.D. "Understanding Alzheimer's Disease." New York: Scribner's, 1988.
  • David L. Carroll. "When Your Loved One Has Alzheimer's Disease: A Caregiver's Guide." New York: Harper and Row, 1989.
  • Lisa P. Gwyther. "Care of Alzheimer's Patients: A Manual for Nursing Home Staff." Washington, DC: American Health Care Association and the Alzheimer's Association, 1985.
  • Nancy L. Mace and Peter V. Rabins, MD. "The 36-Hour Day." Baltimore: The Johns Hopkins University Press.
  • Robinson, B. Spencer, L. White et al. "Understanding Difficult Behaviors: Some Practical Suggestions for Coping with Alzheimer's Disease and Related Illnesses." Ann Arbor: Eastern Michigan University Geriatric Education Center of Michigan, 1988.

 

© 1992 Alzheimer's Disease and Related Disorder Association, Inc. All Rights Reserved.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.