Aug 30, 2010

Alzheimer's Caregiving: Dealing with Urinary Incontinence, The Brain

By Carole B. Larkin
Alzheimer's Reading Room

Previously I wrote -- Alzheimer's Caregiving Avoiding the Urinary Tract Infection (Part Four).

Now let's move on to Incontinence.

Incontinence is usually a part of Alzheimer’s and other dementias because many times in the diseases the portion of the brain that controls our “muscle memory” gets damaged and slowly dies.

When that portion of the brain gets damaged, the brain can no longer send the signals needed to make muscles work as they are supposed to. That includes the muscles serving the bladder and the sphincter.

If the brain doesn’t send the message to contract and hold urine and feces in then you have a problem that takes special attention and consideration.

Incontinence is a process (usually), not an overnight change. The results of periodic incontinence can be proactively addressed and the problem can be solved or lessened. However, the caregiver must be willing to make a serious concerted effort to solve the problem.

Each person has their own urinary/bowel pattern (as Bob calls it) or rhythm (as I call it).

It generally calls for voiding urine every two hours or so and voiding fecal matter an average 2-3 times a day. (Higher numbers for men I think. Don’t ask me why. I don’t know!).

You can determine your loved one’s rhythm by just paying attention to when they go daily and writing it down in a log. The pattern will show up after a week or so. Then, the answer is, take them to the bathroom just before it’s time.

You do this consistently, religiously, every day, and it eventually becomes a pattern itself. You do this in spite of the
“I don’t have to go now response.”

Or, if it’s a, battle, don’t ask! Try
“Mom come here. I have something to show you,”

while you are at the bathroom door. Then when she’s in the room, show her something in there like a magazine or some other item she will be interested in and close the door.

You are either inside with mom or not, depending on what mom will tolerate. If she needs help undressing, you are inside the room. Likewise, if she needs help wiping after urinating (from front to back) you are inside, if she needs help wiping after a bowel movement, you are there --to make sure she is clean.

Some other ways to get mom to the bathroom at the appropriate time are: taking a walk around the house for exercise and ending up in front of the bathroom door while saying
“Well, look where we are! Let’s try to go!”
The above is is called a toileting schedule in the eldercare business.

In some cases you might have to offer a "bribe" to get someone to cooperate. The goal is to establish a pattern, so anything that helps accomplish the goal is worth it.

Some people need to be distracted while on the toilet, to keep them sitting there instead of jumping up before they go. Give them something to hold in their hand like a washcloth.

If they keep jumping up, ask or help them to sit back down again the first few times. If nothing happens, ok maybe they don’t really have to go. Try again later. Some people shouldn’t be distracted with anything while sitting there. After a few trials, you’ll know what your mom needs.

When the problem occurs at night, set an alarm for every 3-4 hours to wake you so that you can take mom to the bathroom. Soon enough you will know what her voiding schedule is during sleeping hours.

To make it easier, you may want to put a toilet chair next to her bed.

I don’t recommend using the same toilet chair as a shower seat, because when you do, you are actually saying to them that it is ok to urinate and/or defecate in the shower, by providing them the tool to do it in.

Likewise, starting incontinence underwear because it’s convenient for YOU, really says to them, it’s ok to go in your pants. Use them when it’s clear that the problem is lack of “muscle memory”, and try not to use them before except in unusual situations, like travelling.

I’m sure that some of you have other tricks that work with mom to head off incontinence and UTI’s.

Let’s hear from you.

Also Read

Alzheimer's Caregiving : Dealing with Bladder Infections and Urinary Incontinence (Part One)

Alzheimer's Caregving: The Role of Communication and Basic Understanding in Solving Incontinence Problems (Part Two)

Alzheimer's Caregving: How Cranberry Juice Fights Bacteria that Cause Urinary Tract Infections (Part Three)

Alzheimer's Caregiving Avoiding the Urinary Tract Infection (Part Four)

Carole Larkin MAG, CMC, DCP, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.

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Original content Carole Larkin, the Alzheimer's Reading Room

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