Urinary Incontinence In Older Adults

WHAT IS INCONTINENCE?

Incontinence is a term used to describe any accidental or involuntary loss of urine from the bladder or bowel motion, feces, or wind from the bowel. The condition ranges in severity from minor involuntary leaks to complete loss of bladder or bowel control.Women in general experience incontinence more often than men. If you’re looking for Women specific information, check out our other article: What Causes Incontinence in Women? It also becomes more common as people get older. There are two distinct categories of incontinence, urinary incontinence and bowel incontinence.


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BLADDER INCONTINENCE

Bladder incontinence occurs due to problems with the muscles and nerves that help the bladder hold or release urine. Leaks may occur when a person coughs or sneezes or when they have a sudden urge to go but can’t get to a bathroom in time. There are five basic types of incontinence:

BLADDER INCONTINENCE

  • Stress Incontinence

    Occurs when you sneeze, cough, laugh, lift heavy objects, exercise, or do other activities that put pressure on your bladder.

  • Urge Incontinence

    This type of incontinence is also known as an overactive bladder (OAB). It is when you leak urine after feeling a sudden, strong urge to go. Signs of OAB include going to the bathroom eight or more times a day and more than once during the night. The urge to urinate may also be felt when you hear or touch running water. Sometimes, you may even get the urge to urinate even if your bladder is empty

  • Mixed Incontinence

    This is a situation when you have more than one type of incontinence. Often stress and urge incontinence can appear together. This type of incontinence tends to be more common in women.

  • Overflow Incontinence

    Occurs when you are not able to empty your bladder completely, so you may leak urine once your bladder is full. This type of incontinence is more common in men.

  • Functional Incontinenc

    Some medical conditions can keep a person from getting to the bathroom in time or cause the person to lose control of their bladder. Examples of illnesses that can cause this type of incontinence includes, arthritis, dementia, multiple sclerosis.

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BOWEL INCONTINENCE

Bowel incontinence, as the term suggests, occurs when people have trouble controlling their bowels. They may pass feces or stools at the wrong time or in the wrong place. They may also pass wind when they don’t mean to or experience staining of their underwear. Often, bowel incontinence appears together with urinary incontinence.

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WHY IS MY LOVED ONE EXPERIENCING INCONTINENCE?

Incontinence can be caused by a range of things. Some common reasons for urinary incontinence are:

  • Urinary Tract Infections (UTIs)
  • Pregnancy and Childbirth
  • Menopause
  • Smoking
  • Obesity
  • Medical Conditions (diabetes, multiple sclerosis, Parkinson’s, dementia, etc.)
  • Medications
  • Hysterectomy

Some common causes of bowel incontinence include:

  • Diarrhea
  • Constipation
  • Muscle Damage or Weakness
  • Nerve Damage
  • Physical Inactivity
  • Childbirth
  • Hemorrhoids
  • Medical Conditions (IBD& IBS)
  • Medications

In addition, older adults who have difficulty moving around independently may experience incontinence because they sometimes can’t get to a bathroom in time. Regardless, with there being so many possible reasons for incontinence, if your loved one is experiencing incontinence, it is best to consult with your doctor to figure out the exact cause. Treating and managing the incontinence with then become less hassled.

For information on how to deal with incontinence in an elderly person with Alzheimer’s or dementia, check out our Ultimate Incontinence Guide.

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CAN INCONTINENCE BE CURED?

Curing incontinence is dependent upon a few factors. Mainly, the cause of incontinence. For example, if it is due to UTIs, smoking, or medications, it can be easily cured with appropriate lifestyle and medication changes. Incontinence due to pregnancy or childbirth can be reduced or completely avoided by doing Kegel exercises.

For incontinence types that can’t be cured, it can be managed better. For example, bladder training is one way of managing incontinence. By using the restroom at set times with regular intervals, instead of waiting for the urge to go, you can slowly regain control over your bladder.

In the rare instance where incontinence is severe, there are surgical options available. Doctors may recommend a sling procedure, where a small ribbon mesh is used to support the bladder.

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DEMENTIA AND INCONTINENCE

As mentioned earlier, one of the causes of incontinence could be due to certain medical conditions. One of these conditions is dementia, which is a condition in which a person suffers from a decline in cognitive functioning and behavioral abilities. This includes thinking, remembering, and reasoning.

Most dementias are generally progressive, where it starts out mild and gradually worsens over time. When severe enough, it can affect a person’s memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention. There are several types of dementias, including Alzheimer’s, Lewy-Body, vascular dementia, and more.

In general, dementia affects older people. It is estimated that around 5% to 8% of all adults above the age of 65 have some form of dementia, with the percentage doubling every 5 years after 65.

Why Does Someone with Dementia Become Incontinent?

With regards to incontinence, middle to late stage dementia is when it happens. During this stage, the progression of dementia will be severe and the person will be completely dependent upon a caregiver for nearly all their needs. They lose their ability to respond to their environment, to communicate, and eventually to control movement. This includes their ability to control their bladder and bowel movements, thereby leading to incontinence.

Dementia Become Incontinent

How to Manage Incontinence in Someone with Dementia?

Being a progressive disease with no cure, there is no way to cure incontinence in someone with dementia either. However, it can be managed so that it doesn’t affect the person’s quality of life by much.

If a person has started to experience incontinence during the middle stages of their dementia, they may only need some assistance from caregiver to get to a bathroom. For example, bladder training can be an option at this stage for some people. Other things that can be done include making a clear path to the bathroom or keep the door open to let the toilet be visible. You can also consider using a portable commode or urinal for the person’s bedroom for night use.

When a person’s dementia reaches the late stages, their ability to communicate will likely be poor. Therefore, at this point, it is important to watch for non-verbal cues such as restlessness or unusual sounds or faces. Some people still do well with bladder training. However, after a certain point, the person with dementia will become completely incontinent and would requite other the use of incontinence products.

Some important points for caregivers to take note include:

  • Give the person plenty of time to empty their bladder and/or bowels.
  • Do not shame or scold the person in case of accidents.
  • Remain calm and supportive.

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HOW TO ADDRESS INCONTINENCE?

Addressing Incontinence with a Doctor

When experiencing incontinence, it is important to consult with a doctor to determine the cause, severity and the appropriate course of action to manage it. This should start with a visit to the individual’s primary doctor, after which a visit to the urologist may be required.

When consulting with the doctor, it is important to have as much information as you can about the person’s incontinence. Make sure to take notes on things such as:

  • Number of times per day the person is incontinent
  • Are they experiencing urinary incontinence or bowel incontinence or both?
  • When did the problem start?
  • Are the person’s clothes saturated or is the person just producing a trickle?
  • Has there been any increase in confusion or any change in behavior?
  • Does the person have fever or pain when going to the toilet?
  • List of the patient’s current medication

In addition to the information you take note of, the doctor may ask other questions as well. And based on those answers, they will work to diagnose the cause of the incontinence.

Addressing Incontinence with Your Loved One

Being incontinent can be difficult and addressing incontinence issues with someone diagnosed with dementia can be daunting. Below are some important things to keep in mind:

  • Use short words or sentences to express yourself and make it easier to follow step-by-step
  • Use familiar and non-serious words. However, use adult language, not baby talk
  • Be alert to non-verbal signs
  • Don’t rush

It is equally important to emotionally support a person with dementia as they often can be confused and disturbed. Always try to stay calm. Stressing out the person can create more problems. Another thing to do is to reassure the person to reduce feelings of embarrassment. And lastly, always respect a person’s need for privacy. You don’t always have to hover while they are using the toilet.

Addressing Incontinence at Home

It can be quite stressful to watch a loved one slowly lose their inability to use the toilet independently. And the for the person themselves, being incontinent can be the cause of much anxiety. The following points can help the person go about their daily life with dignity:

Contact Your Loved One’s Physician

In order to rule out underlying medical conditions that may be causing the incontinence, it is important to consult with a doctor during the early stages itself. This can reduce considerable frustration and embarrassment for them.

Get a Bathroom Routine in Place

For a person with dementia, routine is key. Using the bathroom can also be included in it. Try to keep a log of their toilet use and identify patterns. Based on these patterns, you can try to plan ahead and establish a routine for them to use the bathroom at set timings. This can minimize accidents as well.

Gently Remind to Use the Bathroom

Once a bathroom routine has been established, you will need to encourage your loved one to go to the bathroom at those set timings. Try to give some advance notice and keep the following in mind when doing so:

  • Encourage them to tell you when they need to use the toilet
  • Be aware and prepared for any situation that might trigger an accident
  • Try to understand some attitudes, behaviors, and phrases that your loved one might use when they wish to use the bathroom

Adapt Their Clothing

Being incontinent comes with the risk of accidents. Adapting your loved one’s clothing can make managing it easier. Choose clothes that are easy to wash, has zippers, Velcro closures, and shoes without laces. Changing out of their clothes becomes easier with these minor changes. You can also use protective pads in your loved ones undergarments for additional protection.

We make a clothing item specific to Dementia and Alzheimer’s called the Bear Hug Onesie which you should check out at this link or below. It’s designed to specifically assist with the transition to incontinence by making it easier to change your loved one and ensure they do not get into their diaper:

Make it Easy to Get to the Bathroom and Toilet

For someone with dementia, getting to the bathroom may not be as easy as it seems. They may get disoriented and confused sometimes. Some of the things you can do to make it easier for them to get to the bathroom are:

  • Clear the path to the bathroom
  • Keep the bathroom door open
  • Use signs & markers on the floor and doors
  • Use lights to guide them to the bathroom
  • Remove any door locks
  • Use contrasting color in the bathroom
  • Modify their bed so that it’s easier to get off from

Make it Easy to Get On and Off the Toilet

Once your loved one has made it to the bathroom, getting them to the toilet and to stay there is the next challenge. Modify the bathroom to be dementia friendly. Install bar handles to make it easier to sit down and stand up. You may also consider covering or removing any large mirrors as it may make your loved one feel like they’re being watched.

Once they reach the toilet, let them take as much time as they need. Don’t worry if they need to stand up or sit down multiple times. You can also try to stimulate and keep them calm by running water or playing music. And lastly, respect your loved one’s privacy. Give them the space that they need.

Prepare for Nighttime Accidents

Dementia patients may have the urge to use the bathroom more often at night due to certain medications that they take. When waking up at night, they may experience disorientation and stress due to not knowing where the bathroom is. Some things that can help your loved one are:

  • Limit fluid intake at least two hours before bedtime
  • Ensure that your loved one uses the bathroom just before going to bed
  • Use protective mattress pads and protectors
  • Install night lights or motion sensors to ensure a visible path to the bathroom at night
  • Consider placing a portable commode or urinal in the bedroom in case of an emergency with little notice
  • Use protective and absorbent floor pads which are similar to the ones for beds

Prepare for Accidents in Public

Being incontinent doesn’t mean a person’s movements should be restricted. You just need to plan ahead. Be sure to keep extra protective underwear, pads, and clothing at all times in case of emergencies.

You should also take note of the nearest toilets and those that are easiest to access. However, if accidents do happen, do not panic. Remember, it is accidents may sometimes happen and you should deal with it with confidence.

For more tips on managing incontinence, read The Ultimate Incontinence Guide

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TRANSITIONING TO DIAPERS

During the early stages of incontinence, a person’s dementia is often in the middle stages of progression. They will likely still be able to care for themselves with only minor assistance needed. It can be a good idea to start using incontinence products to learn to manage their incontinence and also make their transition to severe incontinence easier.

For example, in the beginning your loved one can use absorbent pads which are designed to be placed inside normal undergarments using adhesive strips. Incontinence panties and briefs are another option. These look like everyday underwear for men and women, but has an additional waterproof line and built-in cloth pad to absorb urine. They are usually washable and reusable.

As their incontinence worsens, they can progress to using products that can be used for longer periods at a time. Disposable underwear and adult diapers fall into this category. For more information on adult diapers, read Will Insurance Cover Diapers?

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PRODUCTS FOR INCONTINENCE

Depending on the severity of incontinence, there are different types of products that help you manage your symptoms. Pads and protective garments are the most commonly available products. They come in a wide variety of sizes, absorbencies, styles, and colors. Examples include:

  • Adult diapers

    These are similar to disposable diapers used for infants, but are specifically designed for use by adults

  • Absorbent pads

    These are disposable and designed for both men and women. Adhesive strips hold them inside the undergarment.

  • Incontinence panties and briefs

    These look a lot like everyday underwear for men and women, but has an additional waterproof liner and built-in cloth pad to absorb urine. They are usually washable and reusable.

  • Disposable underwear

    These are similar to regular underwear with only one difference. It is designed to be disposable. Some even have tape on the sides so that they are easily adjustable and removable. They come in day and overnight versions.

  • Protective underpads

    These are disposable or reusable flat pads with an absorbent layer on one side and a moisture barrier on the other. They are used to protect mattresses, chairs, and other furniture from urine leaks.

  • Plastic pants

    These fit over regular undergarments and help protect against mild to moderate leaks.

The Bear Hug Onesie

Managing your loved one’s incontinence can be easier when their clothes are adapted for the situation. The Bear Hug Onesie is one such product. One of the benefits of this onesie is that it helps to manage a dementia patient’s transition to adult diapers.

Being kept in diapers might result in refusal to wear them for various reasons and may even cause them to try to remove them, especially during the late stages of dementia. The Bear Hug Onesie can help prevent it by making it nearly impossible for your loved one to remove their diapers. It has a zipper at the back that can only be undone with assistance from another person.

For more details on the Bear Hug Onesie and its benefits, read Bear Hug Onesie

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