It can be incredibly difficult caring for someone living with dementia, particularly if you are caring for a relative and have not had any experience with this type of care previously.
As a carer for a person with dementia, you will find that their needs will change and increase as time goes on and one of the aspects that carers need to consider is how they can help with dementia and incontinence.
Dementia is a general term that covers the symptoms associated with the ongoing decline of a person’s brain function from diseases such as Alzheimer’s, Lewy Body Dementia and Vascular Dementia which all fall into this description of dementia. For the purpose of this article, we will use the term ‘dementia’ to cover many of the degenerative brain diseases that mainly affect older people, but also people with young onset dementia, too.
Urinary incontinence is common in dementia patients. Between 60 and 70% of patients with Alzheimer’s experience incontinence, but this doesn’t need to be seen as inevitable or as something that just needs to be endured and lived with.
There are a variety of reasons why someone with dementia might experience incontinence and the severity can range from leaking a relatively small amount of urine when coughing, sneezing or laughing to double incontinence which is when someone experiences urinary and faecal incontinence at the same time.
Understanding the reason for the incontinence means that the patient’s medical team can make recommendations that may reduce the intensity of the issue which may in turn alleviate the distress felt by the patient and their carers.
Episodes of incontinence may begin in the middle stages of dementia when the patient begins to experience increased confusion and disorientation. They may no longer recognise signs that they need to use a toilet or they may not remember where the toilet is located.
They may also be unwell with other illnesses and no longer understand how to communicate that they have a problem or manage their needs in line with their illness. They also may not recognise signs and symbols on the doors which may add to their upset and distress whilst trying to hold on to their independence.
They may be embarrassed to ask for help or feel like a burden on their loved ones and so may try to hide what is happening which can be difficult for loved ones who want to help and minimise their upset.
There are many reasons why someone might experience incontinence alongside dementia and some of these reasons could just as easily affect someone of the same age who does not have dementia. For example, they may also experience incontinence as a result of other health issues.
People who have given birth may have pelvic floor weakness, hormones could impact continence or people who have had prostate problems may consequently have trouble with their bladder. Particular medications may also cause problems such as increasing the frequency that someone needs to use the toilet or cause loose stools.
The difference between someone with dementia and another older person without dementia is that the dementia patient may gradually begin to experience the following:
If you are a first-time carer for someone with dementia, you may not be aware of what signs to look for that could indicate the start of a problem with incontinence as the person you are looking after may not want to share that they are experiencing problems with using the toilet. As a carer, you can look out for:
This is not an exhaustive list of signs to look out for that someone is trying to hide that they are experiencing incontinence issues; however, you may spot other behaviours that lead you to believe that the person you are caring for needs additional help and support.
One of the most important things a carer can do to help a dementia patient with incontinence is to understand that this is a difficult and upsetting subject for them to deal with.
When we are busy and rushed off our feet, it can be difficult to find the patience to make them feel safe and reassured and that their dignity is being considered and maintained.
If you are unsure of how to handle the continence care of a patient with dementia, here are some suggestions that may help.
Don’t restrict fluid intake – it may seem counterintuitive but reducing fluid intake can make incontinence worse as it can bring about urinary tract infections and constipation.
Give plenty of time for the toilet – somebody who feels rushed may not fully finish what they are doing and then may need to go again in a short period of time. Not fully emptying one’s bladder or bowels can lead to other problems such as a urinary tract infection or constipation.
Ask if they need the toilet regularly – a patient may need reminding that they could need to go to the toilet. Once every two hours should be sufficient.
Improve visibility of the bathroom – some people may struggle to identify the bathroom or the toilet. Symbols for the toilet such as ‘WC’, a wheelchair or a ladies/gents sign may lose meaning as dementia progresses. By labelling the door with the word ‘toilet’, you can potentially avoid confusion. You can also leave the light on in the bathroom at night so if they get up in the night, they’ll more likely gravitate towards the light.
Clear clutter and distractions in the bathroom – the purpose of visiting the toilet is for the patient to empty their bladder and/or bowels and so removing any distractions such as colourfully decorated bottles or soaps may help keep their focus on the task at hand.
Improve visibility of the toilet – as dementia progresses, a patient may struggle to identify a toilet and so making it visible and available is important. Removing waste paper bins and offering a range of suitable alternatives to the bathroom such as a bedside commode or a urinal bottle can help. In the bathroom, you can help by using a toilet cleaner that changes the colour of the water or using a toilet seat light to help people who choose to stand to use the toilet have better visibility.
Offer verbal assistance and reminders – dementia patients may forget the steps for using the toilet and so verbal assistance about what to do next can be helpful e.g. would you like to flush the toilet? Shall we wash our hands now?
Use adaptive clothing – if a patient is hurrying to use the toilet then fiddly buttons can impede their progress. However, elasticated waists, velcro and poppers can be much easier to work with.
Use absorbent pads on beds and chairs – accidents do happen and having absorbent washable pads on beds and chairs can make cleaning up much easier as well as protect mattresses and chairs.
Use incontinence pads or underwear – incontinence pants and incontinence pads have come a long way and many are far more discreet than many people realise.
Being a carer can be hugely rewarding but if you are a first-time carer looking after a relative, it can be an overwhelming experience. There is support available to carers looking after people with dementia either through your GP, or clinical staff such as dementia specialist nurses at the memory clinic may be able to help.
Carers may also be entitled to financial support with carer allowance and possibly other benefits. For practical support, Alzheimer’s Society has resources that can help you understand what technology or home adaptations may be helpful. Alzheimer’s Society also offers a postcode checker so you can see the help that is available in your area such as carer support groups, daytime activities and transport assistance.
Incontinence products at Complete Care Shop
At Complete Care Shop, we stock a comprehensive range of incontinence aids that are specially designed to help people with continence issues. From incontinence underwear to disposable bed pads and barrier cream, there are many ways in which the right products can help you and the person you care for manage incontinence.
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