Managing incontinence in dementia

Jul 27, 2020

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Managing incontinence in dementia

Managing incontinence in dementia

Posted in : Dementia Care on by : Pooja Jain

Not being able to use the bathroom properly and independently is a difficult task, both for you and the person you are caring for. The bathroom is a place we are used to being by ourselves and having our own privacy. When a person starts to need support, it can be difficult to cope with this change. Even though the situation can be uncomfortable and frustrating, it is important to give the person as much respect, dignity and privacy as possible while providing them the help that they need. This article talks about the different ways you can address incontinence. 

If the underlying health issues we mentioned in our previous blog are identified and treated, but incontinence issues still persist, then it’s time to look at ways to manage incontinence. It will be a trial and error process. You’ll also notice that what might work for one day might not for another. This is because factors like mobility, dexterity, motivation for personal hygiene, accessibility to the bathroom and awareness of bladder and bowel movements, will influence which solution to implement. You also might have to implement several of the strategies mentioned below to see an impact. 

Establishing A Routine

Start to observe when the person with dementia usually goes to the bathroom or has accidents. Bladder/stool charting can help with this. There are usually physical and/or behavioural changes that may indicate the need to use the bathroom. For example, they could be fidgeting, going to the corner of the room, pulling on their clothes, and/or feeling uncomfortable and distressed. 

Once you identify the signs, create a routine that encourages them to use the bathroom just before the usual accidents. Also include going to the bathroom after meals and before bedtime into the routine, ensuring a trip to the bathroom is scheduled every 2-3 hours. Eating and drinking at regular times also helps regulate when someone needs to go to the bathroom.

Integrating exercises into the routine can also help regulate continence. Using trips to the bathroom as opportunities to exercise and walk will not only help with mobility and strength training, but also help them stay motivated to move and use the bathroom. Specific exercises such as pelvic floor exercises, also known as Kegel exercises, can be effective for stress, urge and mixed incontinence. Make sure to check with your doctor or physiotherapist before trying these exercises. Ask them to show you the right way to do it to ensure the right muscles are used. 

Communication Strategy 

If the person with dementia is refusing to use the bathroom, we have listed a few ways to encourage them:

  • People with dementia rely on your nonverbal cues such as your facial expressions and body language, so try to appear relaxed and comfortable as possible, even when things get difficult. They will be able to pick up on any frustration or anger on your part, which can make them scared and more resistant. 
  • Use an activity they like to do as the end goal instead of asking or demanding they use the bathroom i.e. “Let’s pop into the bathroom before we go in the garden or before we watch some tv.” 
  • Use short, simple and familiar words when giving instructions, whether it’s getting to the bathroom or using the toilet. 
  • Don’t rush them. Give them enough time in the bathroom to urinate or empty their bowel. 
  • Provide reassurance. This will help them feel less embarrassed.  

Diet and Drinks  

The type of food and drink and when they are consumed impacts continence. 

  • Having a balanced and nutritious diet with enough fluids (6-8 glasses of water a day) will help keep the bladder healthy and regulate the bowel. The doctor or a dietitian can help recommend certain foods and drinks that can help address incontinence, providing a list of what to include (i.e. fiber) and what to avoid (ie.spicy or acidic food). 
  • Caffeine, fizzy drinks, and alcohol can irritate the bladder so it’s best to limit or avoid these drinks. 
  • Keeping hydrated during the day and limiting fluids, especially caffeine and alcohol, close to bedtime can help avoid night time incontinence. 

Creating a pleasant environment  

Bathrooms can be cold and uncomfortable. This can make the person with dementia feel scared. Here are a few ways you can make the bathroom more pleasant:

  • Play music, especially songs they are familiar with and can connect to. 
  • Keep a basket of things in the bathroom that they can hold on to when on the toilet. Sometimes people with dementia don’t know what to do with their hand and giving them something to hold like a toy, towel, or a book can help keep their hands busy. 
  • Keep an eye on the temperature and if possible, try to make the bathroom warmer. 

Home modifications

Below are a few modifications you can make to the home, which will make using the bathroom easier and safer.

  • Having a sign on the bathroom door can help the person with dementia locate the bathroom much easier, especially if they are disoriented or confused. Place it in the person’s line of vision. It is better to use a contrasting colour for the signage to the door. It can also help if the signage is a combination of words in a large font and accompanied with a picture. 
  • Night lights or motion sensors can help lead the person with dementia from their room to the bathroom at night. Having a small light in the bathroom can also help them locate where the bathroom is. 
  • Having grab rails leading to the bathroom and in the bathroom can help if balance and mobility is impacted. It can help them walk to the bathroom, have support when removing clothes, sitting down and getting up from the toilet, thereby maintaining their independence. 
  • A raised toilet seat can also help them get on and off the toilet.
  • Having items in the bathroom in contrasting colours can help. Having the walls, floor and toilet seat in different colours can help them see and differentiate where the floor ends, the walk begins and where the toilet is. Having coloured toilet seats or painted walls can help achieve this. 
  • Removing items that can be mistaken as a toilet can help avoid toileting in inappropriate places. This includes things such as plants, pots, and bins. 
  • Consider adjusting the bed. The person with dementia might not be visiting the bathroom as often as they should because the bed might be too high for them to safely get in and out of.

Skin care 

Incontinence can affect the skin if proper care isn’t taken. To avoid skin irritations, sores, dryness and rashes, make sure:

  • The skin is washed, cleaned and dried thoroughly after an accident
  • To ask your local pharmacist with picking the right soaps and skin creams
  • The person’s skin does not touch protective plastics 

Incontinence products

The aim for incontinence products is to maintain personal hygiene and cleanliness, prevent skin irritation and sores, reduce the risk of infections, decrease falls, and help ease the task for the carer. A continence nurse can help you identify the right incontinence product for your loved one.

  • Commode – Having a commode or a urinal next to the bed can help with overnight incontinence, especially if the bathroom is far from the bedroom.
  • Incontinence pads/ pull-up pants – It is important to find pads that fit properly to avoid leakage, have the right absorbances to help draw the fluid away from the skin, and are comfortable. Be aware of skin problems, such as inflammation, and fungal and yeast infections that can happen if the skin is exposed to moisture and isn’t cleaned at regular intervals.  
  • Washable padded briefs – This is an alternative to incontinence pads, especially if they are being flushed into the toilet. It can also be the more dignified and acceptable option, but increases the washing load for carers. 
  • Male continence sheath – This can be useful for nighttime incontinence. 
  • Bed pads and mattress protectors – This can help keep the bed and mattress clean and dry. There are similar products for chairs as well. 
  • Incontinence alarms and sensors – These alarms can be placed on a bed and are activated by urine. This can let the person with dementia and/or the carer immediately know care is required. It also helps avoid skin damage.
  • Wash dry toilet – This product can help clean and properly dry the skin after the person uses the toilet. This is helpful for those who find it difficult to clean themselves after using the toilet. 

Other assistive products

  • Adaptive clothing – Use clothes that are easy to wear and take off, such as clothes with velcro, elastic waists or wrap around skirts. It will also help if they are easily washable and don’t need ironing. This is especially helpful for people who have difficulty with dexterity or need to quickly remove their clothing because of urge incontinence. These types of simple clothing can give the person with dementia more independence and offer them more privacy. 
  • RADAR key – This refers to the RADAR National Key Scheme (NKS) keys which can give you access to over 9,000 public bathrooms across the UK, specifically made accessible for people with disability and different health conditions. 
  • Adaptive swimsuits – There are swimsuits designed specifically for people with incontinence issues, which make it easy to put on and take off with a secure internal liners. 

Sources

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