INCONTINENCE
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(Alzheimer's Association)
Incontinence is loss of bladder and bowel control. While it may be fairly common for number of the elderly, it usually can be kept under control through medications, exercise or surgery. However, those with Alzheimers tend to have functional incontinence: difficulty finding the bathroom on time, or remembering what to do there, inattentiveness to body signals, and reduced concerned about social appropriateness. It can cause skin breakdown and urinary tract infections. It is expensive and burden some, and can lead to social isolation, increased dependency and finally, placement in a care home.
Incontinence should be medically evaluated. Many conditions can contribute to incontinence: Diabetes, stroke, infections, constipation, prostate problems, or medications such as tranquilizers, sedatives and diuretics. The patient may be referred to a urologist.
· Observe patterns of voiding, when accidents occur, and the time needed to get to the toilet in use it. Share this information with a doctor
· inform the doctor promptly of any sudden onset or worsening of incontinence, or foul smelling or cloudy urine.
TAKE PREVENTATIVE MEASURES
· establish healthy routines, from the time of diagnosis: regular toileting schedule, physical activity, taking 6- 8 classes of caffeine free fluid per day. Avoid alcohol
· make the toilet accessible: install grab bars, raised toilet seats. Put a big sign on the bathroom, light it well, and position the person close to it.
· Encourage the person to be independent and to stay dry. Give praise for success.
· Use easy to remove and easy to clean clothes such a sweat pants, with Velcro fasteners.
GIVE NEEDED ASSISTANCE
· encourage the person to ask to help. If he or she can't ask, watch for clues such as restlessness, making faces, pacing, pulling at clothes
· ask or take them to the toilet every two hours, or according to the persons needs
· if they refuse, urge but do not force
· in bathroom, check pad or undergarments for dryness
· allow the person adequate time. Assist as needed with wiping, flushing
· assist with running water; show them what to do.
· At night time, get the person up at least twice and typical 8 hour sleep night. Use a bedside commode or urinal
USE INCONTINENCE GARMENT SAYS A LAST RESORT
These may encourage incontinence; they are often left wet too long, increasing the dangers of infection and skin breakdown; they are expensive, often humiliating.
· First tried pads, placed in underwear, and ultimately fully absorbent and disposal adult breeze with an elastic waistband. Changes saturated diapers and pants promptly; at least every two hours
· use absorbent, washable bed pads, available at medical supply stores,
· call Help for Incontinence People at 800 579-7900
TAKE CARE OF SKIN
· wash gentle area are with warm water and mild soap when wet clothing or pads are changed. Be sparing with deodorant or powders, which may dry out the skin.
· Inspect skin for signs of breakdown, especially when there is frequent incontinence, itching and burning in groin or on upper thighs and buttocks, ammonia body oder, or pain over the entire affected area
applying moisture barrier cream to affected areas; applied vitamin E oil from capsules to reddened area.
Incontinence: The Caregiver's Role by Kevin McShane (2006)
Incontinence in children is called "training". In adults, it's often called embarrassing. Without understanding the problem, people may jump to the conclusion that their loved one is suddenly getting too lazy or simply doesn't care. This is so rare, that it should be the very last consideration when seeking a cause. Although incontinence is usually not an emergency, problems with incontinence should be reported to the doctor. The gynecologist and the urologist are the specialists who are most familiar with incontinence and can evaluate the causes and recommend several treatment approaches.
There are a number of reasons your loved one may be experiencing incontinence, thus, while it may not seem like a medical emergency, it is wise to inform the doctor when problems are noticed. The specialists more familiar with incontinence are gynecologists and urologists. Depending on the cause of the incontinence, there are several recommended treatments. These should be discussed in detail with the doctor. The following possible causes are not arranged in order of likelihood of occurrence. Such predictions are based on the individual and aggravating or contributing factors.
Dementia, mental confusion or psychological factors.
Cancer.
Restricted mobility.
Urinary tract or prostate enlargement or infection.
Side effects of medications.
Impaired nervous system.
Pelvic muscle weakness.
Nerve or muscle damage after pelvic radiation.
Developmental problems of the bladder.
Pelvic, prostate, or rectal surgery.
Bladder spasms.
When you do speak with the doctor, give the doctor the most appropriate and applicable information. Here is a checklist of things the care recipient should share with the doctor.
Describe your problem.
When does this occur?
How long has incontinence been a problem?
How much of a problem has this condition become?
How many times does this happen each day? •Are you aware of the need to urinate before you leak?
Are you immediately aware that you have passed urine?
Are you wet most of the day?
Do you wear diapers in case of accidents? Occasionally? All the time?
Do you avoid social situations in case of accidents?
History and factors
Do you have a urinary tract infection now? In the past?
Is it more difficult to control your urine when you cough, sneeze, strain, laugh, run, jump or walk?
Is the incontinence worse when sitting up or standing?
Do you suffer from constipation?
Is there anything you can do to reduce or prevent accidents?
Have you ever been treated for this condition before? Did it help?
Have you tried pelvic floor exercises (Kegel)? Did it help?
What surgeries have you had?
What injuries have you had?
What medications do you take?
Do you drink coffee? How much?
Do you drink alcohol? How much? How often?
Do you smoke? How much each day?
Expect and prepare your loved one for the likelihood of a physical exam. For both men and women, expect an abdominal, rectal and neurological exam. Additionally, men are given a genital exam and women a pelvic exam. The doctor will also run a number of diagnostic tests, which will include urinalysis, cystoscopy (checking the bladder) and procedures to check urinary functioning.
You should encourage your loved ones and/or clients to avoid items that irritate the urethra or bladder. Check with your doctor for more specific information. Some of these items include liquids that tend to increase urination (coffee, alcohol), diuretics (water pills), some anti-spasmodic medications, antidepressants and antihistamines, cough/cold medications (they should also avoid coughing, so this may be a tricky one), ventolin (albuterol) or other beta agonists.