Dec 21, 2013

The Role of the Dementia Caregiver - Urinary Tract Infection, Urinary Incontinence

Bladder infections, UTIs, or urinary incontinence can be the source of changes in behavior in Alzheimer's patients. Sometimes these change in behavior are subtle. Sometime the person living with dementia becomes mean spirited or hard to deal with. And, sometimes they become dull and appear to be losing their memory fast.

By Bob DeMarco
Alzheimer's Reading Room

This article is a companion to -- Do you know what happens when an older person has a urinary tract infection and they don't know it?

The Role of the Dementia Caregiver | Alzheimer's Reading Room

One question that I don't think gets asked often when a person shows signs of urinary incontinence is -- is the person (man or woman) getting) some type of infection? I am referring here specifically to persons living with dementia.

Think about it. How many times have you had your loved one tested for a UTI? 
Does your doctor routinely check your loved one for bladder infections. By routinely, I mean every month. I had my mother checked every month, and we took the urine sample with us to the doctors office.

When the problem with urinary incontinence gets bad -- or worse than usual -- do you immediately think you need to have the person tested for a UTI? You should.

If a person is incontinent and they sit or lie around wet (even at night in bed) the likelihood that they could suffer from urinary tract infections goes up, way up.

E.Coli bacteria are the source of bladder infections and UTIs. Damp underwear, or briefs, soaked with pee can be a source of E. Coli.

In the case of my mother, it became obvious to me after years of trying to solve my mother's problem with incontinence that she had a series of undiagnosed bladder infections. I base this on a simple observation -- at times her problem was much worse than at other times.

Later on, I learned that whenever the incontinence worsened she had a UTI.

This was a simple case of one plus one equals two.

As I described in the previous articles, we only discovered that she had a very serious bladder infection by accident.

The UTI that alerted us to this problem was not diagnosed by her personal care physician and he was "top notch". It was discovered because her temperature was slightly elevated from her baseline temperature and I thought she was getting dehydrated. As it turned out she was not dehydrated, the simple test showed the UTI.

This ultimate discovery lead to my current beliefs and also lead me in the direction we needed to go. These findings lead me to an understanding that allowed me to solve the problem of urinary incontinence.

You read this correctly. I solved the problem of urinary incontinence. We did not use drugs or medication, we used what I call

Bunkhouse Logic.

My mother could never tell me she had a urinary tract infection. She had at least 15 and never complained once of being sick. That's Alzheimer's for you.

My mother had "silent" bladder infections. My mother did not feel any pain, discomfort, or burning sensation when she peed. This is why it is called a silent the bladder infection.

Over the years as I first got a "grip" on the UTIs, and then another "grip" on the incontinence, it became clear to me that these two can go hand in hand. 

The bladder infections made my mother's incontinence worse and more difficult to deal with. This in turn made me, the Alzheimer's caregiver, more frustrated.

You should understand that when a person has Alzheimer's disease it is likely that they won't remember peeing on their clothing, pajamas, sofa or on the floor.

If they don't remember, then they don't know that there is a problem. Trying to get them to remember, or convince them that there is a problem is a useless endeavor in my opinion. This kind of communication is counter productive to effective Alzheimer's caregiving.

In fact, trying to convince a person with Alzheimer's that they suffer from incontinence is likely to cause the exact opposite effect that you are trying to obtain. It is likely that you will make the person feel frustrated and angry.

This leads to bad, hard to understand behaviors that are likely to drive you nuts.

Yes, urinary tract infections and/or urinary incontinence can be the source of changes in behavior in Alzheimer's patients. Sometimes these change in behavior are subtle. Sometime the person living with dementia becomes mean spirited or hard to deal with. And, sometimes they become dull and appear to be losing their memory fast.

This in turn is likely to make you, the Alzheimer's caregiver,  angry and frustrated. And yes, your are likely to lash out from time to time. This puts you in an endless cycle that leads to one unhappy day after another.

When an Alzheimer's caregiver becomes angry and frustrated it is likely that they pass these negative emotions on to the person with Alzheimer's disease. Whether a caregivers is conscious of this or not, this leads to a very bad caregiver experience all the way around.

It leads to day after day of emotional and psychological misery for both the loved on e and the caregiver.

I hope you are understanding my point here.

What I am describing is a viscous cycle of bad communication and misunderstanding.

I would ask any Alzheimer's caregiver that is dealing with the very real problem of urinary incontinence to try and understand that you cannot blame the person with Alzheimer's for peeing. If they could do something about it they would do something about it.

I would suggest that the caregiver sit down in a comfortable chair, in a dark room, and think about what I am saying.

Try to put yourself in the place of the person living with dementia.

Try to imagine what it would feel like to pee all over yourself -- over and over.

Don't assume that the Alzheimer's patient doesn't feel shame, anxiety or guilt.

Just because they cannot express themselves does not mean that are not feeling confused.

As a communication paradigm, anxiety (the inability to understand) leads to confusion which leads to mean spirited behavior. It is just that simple.

In closing this article I would suggest that you have your loved one, woman or man, tested for a urinary tract infections frequently -- especially if they are wet or getting wet overnight. I suggest that you make this part of every visit to the doctors office.

Quite frankly, frequent testing is one of the best way to deal with this very vicious problem that most caregivers face on an ongoing basis.

In our case, I obtained the sterile containers that hold the urine, and a urine collector that fits on the toilet and makes it easy to collect the urine and pour it into the container. I took the urine sample right before we left for the doctor's office. I took the sample for testing as soon as we arrived at the doctors office.

We had the result when the doctor comes into the room to examine my mother.

More on this topic, how to deal with the problem, and how we conquered the problem of urinary incontinence coming soon.

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Bob DeMarco is the Founder of the Alzheimer's Reading Room (ARR). Bob is a recognized expert, writer, speaker, and influencer in the Alzheimer's and Dementia Community worldwide. The ARR Knowledge Base contains more than 4,500 articles. Bob lives in Delray Beach, FL.
Original content Bob DeMarco, the Alzheimer's Reading Room