Incontinence

Incontinence can be very upsetting and humiliating for people with dementia as well as stressful for carers. However there are many ways in which you can help prevent or manage incontinence which can improve the situation for everyone concerned. Here are some suggestions.

Incontinence occurs when someone loses control of their bladder (urinary incontinence) or their bowels (faecal incontinence). It may happen all or most of the time or just occasionally. Urinary incontinence is far more common than faecal incontinence but both may be due to conditions which are treatable so the first step is to consult the GP.

Treatable conditions

Among the conditions which may cause urinary incontinence are:

• a urinary tract infection: this usually responds to medication.
• prostate gland trouble (in men): an operation may be advised.
• the side-effects of drugs: the GP may change the drugs or alter the dose.
• severe constipation which causes incontinence through pressure on the bladder: eating foods rich in fibre and drinking plenty of liquid may deal with the constipation. Exercise may also help.

Faecal incontinence may sometimes be caused by severe constipation where diarrhoea leaks out round the hard stool blocking the bowel.

Other sources of help

The GP may also advise on ways to manage the situation where there is no obvious immediate treatment or may refer you to a community nurse or to a continence adviser. The Continence Foundation can also tell you how to get in touch with an adviser in your area. They also run a telephone helpline for all problems to do with incontinence.

The community nurse or continence adviser can make a home visit to assess the situation and suggest strategies or other measures that will make it easier for you and the person with dementia to cope. It helps if you can remain calm and matter of fact when dealing with incontinence and remember that it is not the person's fault.

Useful Strategies

These may include:

• Reminding the person to go to the toilet or taking them at regular intervals. Faecal incontinence can sometimes be managed by taking the person at a set time, if their habits are regular.
• Being aware of signs such as fidgeting, getting up and down or pulling at clothes that may indicate that the person needs to go to the toilet.
• Making sure that the toilet is easy to use. An occupational therapist can advise on aids such as handrails.
• Making sure that the person has clothes that can be quickly removed or unfastened. Velcro fastenings rather than zips or buttons may be simpler if the person has difficulty in managing clothes.
• Avoiding drinks for several hours before the person goes to bed if the person is incontinent at night. However, you should make sure that they drink plenty during the day.
• Making sure that there are no obstacles in the person's way such as awkwardly placed furniture or doors which are hard to open.
• Making sure that they remember where the toilet is. A sign on the door may help or they may need reminding.
• If it is too difficult for the person to get to the toilet, a toilet aid such as a commode may be useful. Your health professional can advise.

Incontinence Aids

If frequent toileting is not sufficient to prevent incontinence there are a variety of measures you can take to make the person more comfortable and to protect items such as clothes and bedding. Some products may be available though the continence adviser or community nurse and others can be bought from a chemist.

• You can protect the mattress with a waterproof cover but make sure that it does not come into contact with the person's skin as it will cause soreness. Special protective covers can be obtained for continental quilts and pillows.
• Special absorbent, reusable undersheets and bed and chair pads are available which enable the person to lie or sit on a dry surface.
• Special pads and pants can be worn, either just at night or night and day, which enable the area next to the person's skin to remain dry. It is important to make sure these are the right absorbency, that they do not chafe and that they are changed as often as necessary.

The health professional can advise on other aids as appropriate.

Hygiene

Incontinence may make the person feel uncomfortable and can lead to skin irritation. Wash the person with mild soap and warm water if they have become wet or soiled and dry carefully before putting on fresh pads or clothes. Used pads or wet or soiled clothes or bedding should be washed immediately or soaked in an airtight container until washed.

Confused behaviour

Sometimes the person with dementia may behave in what seems a rather bizarre way perhaps because they are ashamed of their incontinence or confused about their surroundings. They may hide wet underwear, for example, urinate into a wastepaper basket, or may occasionally wrap their faeces in a parcel and hide them. Although this will be distressing for you, try not to get angry. The person will need reassurance. Discuss ways of coping with your health professional.

Feelings

Try to get over any embarrassment or distaste you may feel about helping the person in such an intimate way. You need to be tactful and sensitive as the situation may also be upsetting for the person with dementia. It may help to discuss your feelings with your health professional. It is important not to let dealing with incontinence get in the way of your relationship.

Further information contact

The Continence Foundation

2 Doughty Street

Telephone helpline: 0191 213 0050

Monday-Friday 9am-6pm.

The information sheet Who can help?, available from the Society for 50p including p&p, may be of help.

March 1997

Page Text supplied by The Alzheimer's Disease Society of Great Britain