incontinence
Edited by: Ayelet Saar - Occupational Therapist. (The article was published in Bulletin No. 19 of the Alzheimer's Israel Association)
Incontinence, which includes both bladder and bowel control, is a serious problem in Alzheimer's patients , and is very common, especially in the final stages of the disease. Of the two "types" of incontinence, the more common is the problem of bladder control. Sometimes, the problem of incontinence seems like the "last straw," even though the problem can be reduced to some extent by changes in the patient's environment, clothing, or habits - it will be necessary to accept the problem as an inseparable part of the patient. If the incontinence is a problem that has only just begun, or if it has worsened, it is advisable to examine the possible causes of this problem. The following questions should be asked:
Physiological/medical factors:
- Does the patient suffer from a bladder infection, an intestinal virus (which may cause diarrhea), or a prostate problem?
- Is the patient constipated? (Severe constipation can cause a problem due to pressure on the bladder area. There are also situations in which constipation will cause a loss of control over passing stool, when fluids – due to pressure on the bladder – “bypass” the hard stool and are excreted in a way that makes it appear as if the patient is suffering from diarrhea).
- Is there another disease, such as diabetes, Parkinson's, etc. Has the patient had a stroke?
- Is the patient using diuretics?
- Are certain medications, such as diuretics (for heart problems) or tranquilizers, causing the problem (it should be remembered that certain medications cause weakening of the bladder muscles or worsening of confusion and judgment).
- Did you withhold fluids from the patient when they started having bladder control problems? Sometimes, this can lead to dehydration – which in turn causes bladder inflammation. This inflammation will only make the bladder control problem worse.
- Does the patient suffer from a physical disability (such as a hip fracture, osteoporosis, etc.) that causes him difficulty getting to the bathroom on time?
- It should be remembered that weak pelvic muscles in older women can cause the same problem.
Mental factors :
- Is the problem caused by a state of depression (which may cause apathy), increased confusion, or mental stress?
- Does fear of an "accident" cause the patient to go to the bathroom excessively frequently?
- Is the problem caused by a particular movement (such as releasing urine while sneezing, coughing, or laughing).
Environmental factors :
- Are there factors in the patient's environment (a lot of furniture, a dark corridor, etc.) that prevent him from reaching the bathroom on time?
- Does the patient not know where the toilets are located?
- Are the toilets too far away?
Additional factors :
- Does the patient drink beverages that may cause an increase in the need to urinate (drinks containing caffeine or theine, such as cola, coffee, or tea)?
- Is the patient wearing clothing that will limit their ability to remove it in the bathroom (such as buttons, zippers, hooks, etc.)?
Coping methods:
It is advisable to establish a regular routine for going to the bathroom (even if the patient has not expressed a desire/need to go), especially after meals, drinking beverages, getting up for the day, before going to bed at night, and so on.
Pay attention to early signs (such as restlessness, fiddling with shirt buttons, or trying to take off pants), as these may be ways in which the patient expresses his desire to go to the bathroom.
It is advisable to dress the patient in comfortable clothing that can be removed (such as sweatpants or a dress or a bathrobe). If it is necessary to use a clothing accessory such as a button, zipper or hook, it is advisable to replace it with a piece of "Velcro" (orcleV), for quick removal of the garment if necessary.
It is necessary to ensure that the bathroom is comfortable and warm enough for the patient (especially in winter). If there is difficulty sitting and standing, it is advisable to install a diagonal bar next to the toilet, which will help the patient if necessary.
Make sure that the path to the bathroom is free of obstacles, is not too long, and that the door can be opened easily (it is important to remove any internal lock in the bathroom, so that it does not remain "stuck inside", without any understanding and insight into opening a lock in order to exit the bathroom).
It is advisable to mark the bathroom door with a visual and prominent drawing that will help the patient find his way.
Make sure that the patient defecates in the bathroom (sometimes, the patient will enter, forget the purpose of his visit, and leave again) and help him if necessary (taking off clothing, putting it back on, handing him toilet paper, and flushing the toilet). Sometimes, it is necessary to "encourage" defecation, by giving him a glass of water or flushing the toilet.
If the problem occurs or worsens at night, it is advisable to avoid drinking for several hours before bedtime.
It is advisable to avoid wearing pajama pants or a similar item at night (for example, women can wear a loose, airy nightgown), since the patient - who is more confused when getting up to use the bathroom at these times than during the day - may not have time to take off his clothes/not understand that they need to be removed in a timely manner.
It is advisable to install special night lighting in the bathroom/corridor.
It is advisable to protect home furniture (such as sofas, armchairs, and chairs) with a liquid-resistant cover . If necessary, a suitable nylon surface should be spread over a bed mattress, in a way that is discreet and will not harm the patient.
Additional tips:
Be willing to try new and different ideas on the subject. Remember that every patient behaves differently and what helps one person may not affect/hinder another.
Remember that "wetting accidents" can be embarrassing for the patient. Be as "casual" as possible and do not accuse or scold him unnecessarily. You can also use a sense of humor to reduce tension (e.g., "It must have happened because we ate so much watermelon..")
When the patient goes to the bathroom and succeeds in the task, it is advisable to encourage and praise him as much as possible.
Ask the patient regularly if he needs to go to the bathroom . Do not wait for him to ask, as he may not always be able to do so.
If there are specific hours/times when the patient needs to go to the bathroom, it is a good idea to write them down on a piece of paper in order to remember them and make them a routine.
The patient should be allowed enough time in the bathroom to relieve himself. We must remember that his actions are slower and even confused, and there is no point in rushing him.
Pay attention to sensitive skin areas, which may develop rashes, infections, and even wounds during treatment. If there is a problem checking these areas while going to the bathroom, it is advisable to check them thoroughly while showering.
If necessary, it is advisable to use overnight/all-day pads, or diapers in different sizes. Make sure that all other options have been considered before resorting to using these items!!
It should be remembered that some patients behave in a confused manner in their response to the problem of incontinence. They may try to hide wet clothes or used diapers (and forget where they put them), urinate into a trash can or other container, or even wrap up remains of feces and bury them in hidden places (in extreme cases, the patient may try to "taste" them). It is important to try to restrain yourself and not get angry or scold, since the patient does not understand or control his actions. In such a case, it is advisable and preferable to contact professionals who can provide appropriate advice and support.
It is important to remember that certain medications given to treat incontinence may cause side effects such as dry mouth or eyes. It is advisable to monitor any changes in the patient's condition and consult with your family doctor.
Despite having a problem with incontinence, the patient should be allowed to drink at least 6-7 glasses a day. Dehydration will lead to a whole host of other problems.
It is advisable to seek help early in the problem rather than trying to deal with it alone. Advice and support will help you deal with the issue. Call the association.