Alzheimers and Incontinence

by Nancy Weikel, RN This article offers a short overview of Alzheimer's along with detailed suggestions on managing the incontinence of a person with Alzheimer's

Basic areas covered in this article are:

example of a woman with alzheimers and incontinence
  1. Alzheimer's and Incontinence
  2. Common Causes of Incontinence
  3. Use of Reusable and Disposable Products
  4. Dealing with Behavioral Issues and Stress
  5. Ruling out Medical Conditions
  6. The Different Styles of Incontinence Products
  7. Choosing a Product
  8. Supportive Care for Incontinence
  9. Summary


Alzheimer's and Incontinence
Alzheimer's is the most common form of dementia. It develops slowly over time, often so gradually it is mistaken for normal aging. It is a progressive, degenerative brain disease. Changes in the brain can begin 10 or 20 years before any symptoms appear. Memory loss is usually the first noticeable sign as well as behavioral issues. The affected person over time loses the ability to take care of themselves. They eventually require full-time care. Dealing with incontinence is a common issue for people afflicted with Alzheimer's. With Alzheimer's and incontinence, learning to recognize symptoms is important. Also important is being prepared for future incontinence symptoms.

man with incontinence and wife at his sideCommon Causes of Incontinence
A common cause of incontinence in a person with Alzheimer's is as simple as not recognizing the need to use the bathroom or forgetting where it is. Medications might become an issue as far as taking them appropriately. Stress can bring out the worst in the afflicted person's character. They may have trouble dressing and undressing, causing leakage on the clothing. They may become limited in their physical abilities. They may become physically incontinent in either urine or feces or both. They may even become constipated. Constipation can be due to diet, lack of exercise, and lack of appropriate hydration. The caregiver needs to be aware of any signs of trouble before it becomes a major issue.

Incontinence can become a severe problem for people with Alzheimer's, especially in the advanced stages of the disease. Since they are losing their ability to reason and understand what is happening to them, they can be resistant to assistance. They may even resist the incontinence products.

These afflicted individuals are accustomed to maintaining their own personal hygiene and wearing undergarments made of cotton. They retain the desire to care for themselves, but lack the capacity to do so. Many caretakers are challenged daily with keeping a protective incontinence product on their loved one. Many people afflicted with Alzheimer's incontinence productwill resist using incontinence products. They also may resist assistance in changing the pull-ups or briefs.

Poor hygiene can cause sores to develop in the surrounding skin and tissue causing serious health issues. At all times protect the body's skin. The skin is the body's largest organ and protects us from diseases and infections. A good quality incontinence product will keep the urine and feces away from the skin. Wipes and washcloths can be kept around the house for spot cleansing.

Use of Reusable and Disposable Incontinence Products
Proper use of reusable or disposable incontinence products is important in maintaining healthy skin. The urine needs to be wicked away from the skin's surface. It's important that the skin is kept dry. Clean feces from the skin as soon as possible. Skin breakdown in elderly and bedridden people can take longer to heal than in a normal healthy person. If the product being used for incontinence is not maintaining healthy skin, change things. Do this by changing the product more often, or trying different brands and styles until a better product is found.

products for incontinenceStart the afflicted person on incontinence products early in the disease. It is important to do this while there is reasoning and cognitive thinking. This helps them understand what is happening or going to happen with their bowel and bladder control. The afflicted person needs to understand the progression of the disease and what may lie ahead. This can help prepare their mind for future needs of controlling urine or feces. This is good preparation for when they are no longer rational in their daily life.

Dealing with Behavioral Issues and Stress
The development of incontinence in a person with Alzheimer's can be extremely stressful on the caregiver. The caregiver is now dealing with urine leakage, dirty linen, smells, and embarrassment. For some, fecal incontinence develops as well. Get help from a professional early in the process to learn to manage the incontinence. This is sometimes very difficult for the caregiver to deal with since it is such an intimate need. Try relieving the stress with a little humor.

Incontinence can also be very stressful for the person with dementia, adding more behavioral problems. They are not able to control what is happening to them and many will resist disposable products at first. Be firm with the afflicted person but yet gentle and calm. incontinence doctorFinding a product that is comfortable and that the afflicted person will wear. This is key to managing their incontinence. Also keep a box of wet wipes closely available for easy clean up.

Rule out Medical Conditions that May be Causing the Incontinence
When dealing with Alzheimer's and incontinence, keep in mind other issues that can aggravate or cause the condition. A urinary tract infection will sometimes happen without symptoms, but will cause the person to be incontinent. A physical disability in addition to the Alzheimer's can keep a person from reaching the bathroom in time. Medications may cause the bladder to relax and can cause leakage. Examples are sleeping pills or anxiety reducing drugs. Certain foods aggravate incontinence by increasing urination. These include some medications like diuretics and also drinks like colas, coffee, and tea. Other diseases may affect the urinary tract system like diabetes and kidney failure.

When seeking professional advice be knowledgeable of the issue. Know when the incontinence started. Also, know its frequency, amount, and type (fecal or urine or both). Know any changes in behavior, fever, or difficulty toileting. Then discuss what you have been doing to deal with it and what your needs are at the moment. Be sure and discuss what might lie ahead in the future. If the professional does not find a medical reason for the incontinence then the answer becomes control and, if possible, prevention.

The Different Styles of Incontinence Products
There are many different styles of incontinence products designed for adults from disposable to reusable. There are pull-ups, briefs (diapers with tabs), belted garments, women's pads, and men's pads. The pull-ups & belted garments will be the easiest to begin with. They pull on and off like regular underwear. incontinence productAlways remember, snug fitting legs help prevent leakage. There are pull-ups for overnight incontinence and less absorbent ones for daytime use. Which pull up will work the best depends on the amount of urine to absorb. The briefs have tabs that allow them to open up like a diaper. Briefs are extremely helpful when someone is in bed.

The disposable incontinence products have many different features. These include cuffed legs to help prevent leakage, and plastic vs cloth backing. Some are designed to feel like real underwear. Also, some products are designed specifically for men or women.

Many caregivers use the reusable incontinence products when they have trouble keeping the disposables on the person or to save long-term costs. There are panties for women with light incontinence that a pad can be added to for heavier incontinence. There are briefs for men with light incontinence that look and feel like real underwear. One brand even has a functional fly. For the person with heavy to overnight incontinence there are cloth diapers with snaps. These cloth briefs with snaps are re-washable over 200 times. They come in a variety of sizes, styles, and absorbency.

The incontinence products chosen need to feel as close as possible to what the person was wearing when he or she became ill. Comfortable and well-fitting products are less confusing for the afflicted person. They're also easier for the caregiver to manage. They lessen the chance that the incontinence productafflicted person will pull the product off. After all, they probably did not pull off their underwear as adults before they became ill and their natural instincts will still apply. To minimize the resistance to wearing them, it's best that the product looks and feels like regular underwear. Products do not have to be bulky to be effective. A quality product can be thin and highly absorbent at the same time. There is an endless variety of products available online. These include ones designed specifically for urine, feces, or for plus sized people. Proper fit is the key to success.

Choosing a Product
The first step in choosing a product is to learn about the different styles and their purposes. Pads fit inside regular underwear. Pull-ups, also called protective underwear are the closest in design to real underwear. They have the added benefit of tear-away sides for easy removal. Belted undergarments are a hybrid style between pads and pull-ups; they are like a large pad held on by a belt. Briefs (diapers) have tabs on the sides for a secure fit and convenient changing. Reusable products can be an excellent money-saving choice and are more readily available online. Online product descriptions should include what level of incontinence they are designed for and size ranges for achieving the best fit. Incontinence products are designed for all stages of incontinence from the dribble to the full bladder loss. Overnight products holding the most urine.

There are great reusable and disposable bed pads to protect furniture. They are designed from the small pad for chairs to the king size mattress cover. Deodorizers are made to eliminate orders keeping the room air smelling fresh.

Supportive Care for Incontinence
Supportive care involves both mental and physical support. In the person with Alzheimer's daily life, try to be as supportive as possible with this new very stressful dilemma. Make sure the loved one has easy access to the bathroom without obstacles or clutter. Make sure their clothing is easy to remove. Most of all if your loved one develops incontinence, reassure them you are going to help them. Don't scold or get mad at them. If in public, help them with the embarrassment by saying 'You spilled your drink' or some other phrase to help them through the situation. Respect their privacy and don't make them feel guilty. Most of all, try not to get mad at them.healthy fruit Above all else, don't reduce their fluid intake. It is not something they can control. It is unfortunate when incontinence develops, but the sooner it is kept under control, the less of an issue it becomes. Regular timed trips to the bathroom can help regulate the body.

Diet and exercise can help prevent incontinence by treating the body as a whole. Exercise keeps the muscles that support the bladder stronger and thus helps to prevent urine leakage. Removing fluids that contain diuretics also helps with controlling leakage and maintaining a healthy diet. Some foods will actually worsen the incontinence. Some spicy or acidic foods will make urinary incontinence worse, and alcoholic beverages can cause issues as well. Drinking a lot of water helps maintain a healthy urinary system.

In Summary Manage, Manage, Manage to Maintain Control and to Help Keep their Respect

  1. First, confirm with your doctor that there is not an underlying medical condition creating the incontinence.
  2. Manage through using incontinence products to control the urine and fecal leakage. There are products for every level of incontinence from the dribbler to the full bladder loss including loss of fecal control.
  3. Omit liquids that are similar to diuretics to reduce the frequency of urination and try to keep a healthy diet to maintain physical health.
  4. Use daily exercise while they are able to keep their body fit.
  5. Start a habit of having them go to the bathroom every 2 hours when they are awake by using a timer. This will help to get to the bathroom on time.
  6. Protect the body's skin. It is an organ that protects us from diseases and infections. Proper care of our skin is of utmost importance. Keep the urine and feces away from the skin using good incontinence products. Keep a package of wipes or washcloths by the commode for spot cleansing.
  7. Protection of the furniture is important too. There are nice pads whether the bed is twin up to king size along with smaller pads for chairs and furniture.
  8. Use deodorizers to help keep the room fresh.
  9. Most of all don't get frustrated, it only increases the stress on both parties involved. Be ahead of the issue by starting to manage incontinence before it begins. Plan ahead so that you are prepared.
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About the Author: Nancy Weikel, RN is a registered nurse in Caldwell, Idaho who consults with and writes for IDiaper.com. She has been a consultant for IDiaper for six years.