Dementia and the I word

Dementia Aware: what you need to know about managing incontinence in the person with dementia

 

One of the many challenges that people with dementia face as the dementia progresses, is the loss of ability to control urination and bowel movements (incontinence).

 

It is estimated that approximately 60 to 70 percent of people with dementia will develop incontinence, with urine incontinence occurring first and then, as the dementia progresses, fecal incontinence. Many caregivers state that fecal incontinence is one of the most challenging things to deal with and it is one of the main reasons why a person with dementia may have to move to a nursing home.

 

Caring for a person with dementia who is incontinent, is emotionally and physically exhausting. For the person with dementia, there is a loss of dignity and self worth. There may also be feelings of shame and embarrassment, disgust, despair and frustration. Incontinence can affect social relationships and sexuality resulting in withdrawal, depression and behavioural issues.

 

The person with dementia may:

  • Hide soiled pads, underwear, clothing out of shame and embarrassment
  • May try to flush soiled products down the toilet
  • Refuse to wear pads or adult briefs
  • Become angry and combative when caregiver tries to clean him/her
  • Place hands down soiled underwear

 

There are many reasons why the person with dementia may experience incontinence:

  • Medical problem: bladder infection, constipation, prostate enlargement, prolapse, medications such as diuretics, blood pressure pills, sleeping pills, antidepressants
  • Difficulty getting to bedroom: clutter, poor lighting
  • Unable to find bathroom
  • Unable to move quickly enough: mobility issues
  • Difficulty with undoing belt or zipper, pulling down underwear
  • No longer recognizes the need to urinate and defecate

 

Environmental changes that may help:

  • Easy access to bathroom: remove obstacles, good lighting, leave door open
  • Cover mirrors if person with dementia finds them disturbing
  • Adaptive equipment: raised toilet seat, bedside commode, grab bars
  • Cover mattress with protective plastic sheet
  • Use absorbent soaker pads, also called bed pads or under pads, on top of bed sheet and on chairs and car seat
  • Place sign on bathroom door for easy identification
  • At night, leave bathroom light on
  • Ensure wash cloths and continence products are within reach

 

Management of incontinence:

  • Try a toileting schedule: upon awakening, before and after meals, at bedtime
  • Do not restrict fluids as this can lead to serious medical problems: dehydration, delirium.
  • Stop drinking fluids two hours before bedtime
  • Eat a healthy diet with plenty of fibre as it will help produce a formed stool (constipation may result in overflow liquid faeces)
  • Encourage activity: go for walks, Minds in Motion fitness program (Alzheimer Society of BC)
  • Use belts and pants with snaps or Velcro, pants with elasticated waistband
  • Maintain good hygiene, always clean area (front to back), inspect skin for any irritation, apply barrier cream (do not apply powder)
  • Replace regular underwear with pull on adult briefs
  • If not already receiving assistance from community care or private care agency, now would be a good time to ask for help
  • Report any foul smell, discharge, itching, bleeding or sores to the Doctor

 

Sometimes, the person with dementia and caregiver are reluctant to leave their home, and this can limit their social and physical activity. This can have a negative impact on quality of life and can result in the person with dementia becoming more dependent on caregiver thus increasing caregiver stress.

 

Strategies that may help are:

  • Use toilet before leaving home
  • Wear vinyl underwear over absorbent brief to reduce possible leakage
  • Pack bag with change of clothes, wipes and products
  • In a public place, e.g. restaurant, locate nearest bathroom and try to sit nearby
  • If you are going to an all-day event or travelling ask your Doctor if an occlusive device (clamp to penis to stop flow of urine), or condom catheter (condom with tubing and sealed bag), or anal plug (prevent leakage of feces) is appropriate to help manage the incontinence.

 

There are different types of continence products available for men and women: vinyl pull on underpants, adult briefs, overnight pads, male guards and disposable absorbent pads. These products can be purchased at pharmacies, Costco and grocery stores. The most popular brands are Depends and Tena, although many stores will offer a NoName brand. When choosing a product, ensure it is the correct size and appropriate absorbency. Prices vary between stores, and depending on the frequency of pad/brief changes per day, it can become quite expensive; however, coupons and free samples of products are available @ www.depend.com/Support/Incontinence; www.tena.ca whilst www.canmeddirect.ca offers coupons, free samples, discount products and home delivery.

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