Alzheimer’s or Dementia

Alzheimer’s Disease and Incontinence

Alzheimer’s disease is a type of dementia that affects the nerve cells in the brain. A protein build-up called “plaque” damages brain tissue. Over time, the plaque continues to grow, affecting many parts of the brain. More than half of those with Alzheimer’s will suffer from incontinence issues, between 60 and 70%. Urinary Incontinence is not certain with Alzheimer’s disease, although it is common in the middle to late stages. If it occurs, evaluation by the doctor should determine if other causes of incontinence are present. Other causes of incontinence include:

• Urinary tract infection (UTI)
• Constipation
• Prostate enlargement
• Diabetes
• Stroke
• Muscular disorders such as Parkinson’s disease
• A physical disability that limits movement, making it hard to get to the bathroom in time

Facts About Alzheimer's Patients

For those suffering from Alzheimer’s disease, incontinence can be caused by the inability to recognize the need to use the bathroom. They may forget where the bathroom is or they may know they need to urinate but not remember what to do. When symptoms of incontinence start, they may not be related to Alzheimer’s at all. Here are some reasons a person with Alzheimer’s may have difficulty with incontinence:

• Not reacting quickly enough to the sensation of needing to void
• Not being able to tell someone they need help
• Not letting others help with toileting or refusing help due to embarrassment
• If depressed or distracted they may not be motivated to find a bathroom
• They have experienced an embarrassing episode of incontinence and try to manage independently, hiding soiled clothing

Medications for Memory, Cognition, and Dementia

• Sleeping pills
• Anxiety reducing medications that can relax the bladder muscles
• Diuretic medication (usually taken for blood pressure)
• Foods with caffeine (coffee, tea, cola, soda)

Those with Alzheimer’s may move slowly. Clothing and the surrounding environment can make it difficult to get to the bathroom in a timely fashion to avoid the incontinent episode. Here are a few tips to help:

Helpful Tips for Alzheimer's Patients

• Make sure the patient is wearing clothing that is easy to remove and put on
• Make sure the bathroom is easy to locate
• Adequate lighting is helpful
• Keep the pathway clear of obstacles

Maintaining hydration is very important. Don’t limit fluid intake. Dehydration can lead to a urinary tract infection which can increase incontinence episodes.

Managing Incontinence in the Alzheimer’s patients

Establishing a routine for toileting can help minimize incontinent episodes. Remind the patient at regular intervals to use the bathroom. Every 2 hours is a good goal. Learn the bowel habit routine of the patient. They may typically need to use the toilet around the same time each day. Use adult words or terminology. Using “baby talk” can be demoralizing. Encourage the person to communicate, telling you if they need to use the bathroom. As some patients with middle to late stages of Alzheimer’s disease, they may not have the ability to tell you verbally. It is important for the caregiver to watch for non-verbal cues. These include:

• Sudden restlessness
• Looking around aimlessly (looking confused)
• Making unusual sounds or facial expressions
• Pacing
• Sudden silence
• Hiding in a corner

As Alzheimer’s disease progresses, the patient may use other words or phrases that have nothing to do with needing a bathroom, to communicate they need to use the toilet. An example is “I can’t find the light.” Learn their phrases.

Be sure the bathroom is easy to find for Alzheimer's patients.

Alzheimer's patients Home Care Tips 

• Keep the door open, making the toilet visible
• Paint the door to the bathroom a different color from the wall
• Make the toilet easy to use. Physical limitations may make it difficult. Grab bars on the sides of the toilet can help.
• Raise the toilet seat if needed
• Keep the light on in the bathroom
• Consider a bedside commode at night or a urinal at the bedside

Monitor fluid intake. Encourage fluids during the day but limit intake to about 2 hours before bedtime. Try to avoid caffeinated drinks that increase urination such as coffee, tea, and colas.

Establish routines to minimize accidents. As mentioned earlier, toilet at regular intervals such as after meals.

Keep incontinence products available. These will help keep embarrassing incontinent episodes to a minimum for the patient. 

Best Incontinence Products for 2024

• Depends on Incontinence Guards for Men
• Condom catheters for men
• Medline Fit Right Ultra Adult Briefs
• Prevail Protective Underwear
• Medline Fit Right Personal Cleansing Wipes
• Cavilon Durable Barrier Cream
• Disposable or Reusable Underpads
• Mattress protectors for nighttime use

Alzheimer’s disease starts with mild symptoms and progresses with time. In the beginning, patients are often aware of the changes in their memory. They may retreat from socializing with others. As memory loss increases and they move into the middle and late stages of the disease, they become less aware of what is happening around them. It is important to help this population maintain dignity as they lose control. If you are a caregiver, remember to take care of yourself. By doing this, you can be a better provider of care to your loved one.

 

Author Profile: Christine Kijek, Registered Colorectal Nurse

 

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