Caring for Alzheimer's Seniors: Incontinence

Chris Hawkins Written by Chris Hawkins
SeniorLiving.Org Expert on Senior Care & Assisted Living

Incontinence—complete loss of bladder or bowel control—is one of the more unpleasant aspects of Alzheimer’s disease for patient and caregiver. It effects up to 70% of those with Alzheimer’s; Chances are good that your loved one will experience it.

Alzheimer's & Incontinence

Because each person with Alzheimer’s experiences the disease differently, no one care giving formula exists. But as humans and caregivers, we can quickly adapt to just about any situation. The more caregiver tools you have in your toolbox, the better equipped you’ll be for “fixing” or at least coping with your charge.

In Part 1, we covered topics such as communication, activities, eating, bathing and dressing. Here we’ll talk about incontinence, depression and dealing with behaviors like aggression.

And while incontinence is not a normal part of getting old—as popularly believed—it is common in those suffering from Alzheimer’s for a number of reasons. But according to the U.S. National Library of Medicine, “In most cases of urge incontinence, no cause can be found.”

Types of Incontinence

Normally, your nervous system tells you that you need to urinate. During urination, your detrusor muscle contracts and forces urine out of the bladder. At the same time, your sphincter muscle must relax for urine to flow out.

Urgency Urinary Incontinence (urge incontinence) or Overactive Bladder (OAB) is the strong need to pass urine due to bladder spasms or contractions. It is more common in women than in men.

But in some seniors, they either never get the message or they have some other physiological issue. Here are some of the medical conditions can cause urge incontinence including:

  • Bladder inflammation
  • Bladder stones
  • Bladder cancer
  • Bladder outlet obstruction
  • Enlarged prostate (in men)
  • Benign prostatic hypertrophy or BPH (in men)
  • Nervous system diseases such as MS
  • Spinal cord injury, stroke, dementia and Alzheimer’s

Stress Urinary Incontinence (SUI) results from weak pelvic floor muscles and/or a deficient urethral sphincter. With SUI, the bladder leaks when body movement (laughing, coughing, exercise) puts pressure on the bladder.

Fecal Incontinence occurs when you are unable to control passing liquid and/or solid stool. In Alzheimer’s seniors, it’s usually caused by either a weak or damaged anal sphincter muscle or damage to the nervous system.

Natural aging can cause a weakened sphincter muscle and so can constipation.

Testing for Incontinence

The following are common tests for urinary incontinence:

  • Pelvic or abdominal ultrasound
  • Urinalysis
  • Urinary stress test
  • Bladder examination (cystoscopy)
  • X-rays with contrast dye

The following are common tests for fecal incontinence:

  • Rectal ultrasound (endosonography)
  • Flexible colonoscopy
  • Manometry
  • Defecography
  • Electromyolography (EMG)

Causes of Incontinence in Alzheimer’s Seniors

Other than the causes listed above, the following can cause incontinence in Alzheimer’s seniors:

  • Certain medications like sleeping pills or anxiety-reduction drugs can relax the bladder muscles
  • Diuretic drinks such as coffee, tea and cola
  • A physical disability that may inhibit one from reaching the bathroom
  • Unable to remember where the bathroom is located
  • Forgetting what to do once in the bathroom
  • Obstacles (furniture, stairs, improper light, etc.) in the way of the bathroom
  • Clothing that is difficult to open or remove
  • Dehydration, which leads to incontinence

Tips for Dealing with Incontinence

As we said earlier, Alzheimer’s affects everyone differently.

But one of the universally most effective things you can do is set a “Toilet Time” schedule. First, keep a log of when they are going both number 1 and number 2. Then set a schedule for them to sue the bathroom. Ideally, this will be every 2 to 4 hours.

  • Look for signs they need to go such as nervousness, restlessness, fidgeting, rubbing legs or arms, touching genitals, squeezing legs together, pulling at clothes.
  • Make sure all obstacles are cleared from the pathway to the bathroom.
  • Make sure the bathroom and the path to the bathroom is well lit.
  • Keep clutter out of the bathroom and make it warm (physically) and homelike.
  • Try elevated toilet seats, padded seats and handrails.
  • Put a sign on the door indicating “bathroom”.
  • Have them wear clothing with elastic waistbands and replace buttons and zippers with Velcro so they are easier to get in and out of. Conditions such as arthritis can exacerbate the process.
  • Accompany them to the bathroom.
  • Do not rush their time in the bathroom.
  • Don’t use baby talk or a condescending voice.
  • Say “We” instead of “You”.
  • Demonstrate how to use the toilet if needed.
  • Use rewards if you have to; after they go successfully, give them their favorite snack.
  • Avoid giving them spicy or acid foods that can irritate the bladder.
  • Limit drinking with meals to 8 ounces or less.

If your loved one needs home care because of Alzheimer’s, search the extensive Seniorliving.org database for a provider near you. You’ll also find senior living facilities that specialize in Alzheimer’s care.

For further reading on Alzheimer’s:

“An Introduction to Alzheimer’s”

“Causes of Alzheimer’s”

“Caring for Alzheimer’s Seniors: Part 1”

“How to Approach a Person with Alzheimer’s”

“Caring for Alzheimer’s Seniors: Part 3”

Updated: May 21, 2012

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