Incontinence and incontinence care are two subjects of conversation that no one likes to talk about. These are both difficult and sensitive issues, but the results are clear. The painful proof is an obvious stain on your parent’s pants. Incontinence and incontinence care can lead to embarrassment, shame, and confusion for both you and your parent. It shouldn’t, however, result in public humiliation or ridicule. Incontinence is a common problem for seniors and there are ways to manage an embarrassing situation with advanced preparation.
What Causes Incontinence in the Elderly?
Incontinence is often caused by weakened bladder muscles. The bladder plays a key part in human urination. Picture your bladder as a sponge which stores urine. Going to the bathroom is like squeezing a wet sponge. The tightening bladder muscles force urine into a tube called the urethra to exit the body. A senior’s older muscles can weaken and don’t often work well or even in the same way they did years before. When the bladder muscles fail, urine can leak out – often without a senior noticing. While both human genders are susceptible, incontinence occurs more often with women.
Other indications of incontinence include the following:
- Physical inactivity
- Certain chronic health problems
- Previous removal of gallbladder
- History of smoking
Types of Incontinence
To better manage incontinence care, you will need to know more about the cause for your loved one. Pinpoint the type of incontinence you are dealing with from this list:
- Stress Incontinence. No, this is not related to any undue stress that a person may feel. Sudden movement (e.g. jumping, coughing, or laughing) can lead to incontinence. Usually, the following leakage is slight.
- Urge Incontinence. Seniors with urge incontinence will often need to rush to the closest bathroom even when their bladder is not completely full. If the senior does not reach a bathroom in time or finds it already in use, accidents can frequently happen.
- Mixed Incontinence. A combination of stress and urge incontinence leads to mixed incontinence.
- Overflow Incontinence. Does your parent experience urine leakage without knowledge? Your parent may have overflow incontinence caused by a block in the urine flow. Compare this with a vacuum with a sock stuck in its hose. The machine will still want to work but lacks the ability to function correctly.
- Functional Incontinence. This is often seen with seniors with dementia. When a senior may not realize the need to go to the bathroom incontinence care becomes more difficult. Even if seniors can reach a bathroom in time, they may not know what to do when they get there. If they don't remember or aren't able to pull down a pair of pants or transfer from a wheelchair to a toilet seat, accidents occur.
- Reflex Incontinence. A senior’s bladder muscles may suddenly tighten resulting in larger urine leaks. This type of incontinence is more prevalent in seniors suffering from multiple sclerosis or spinal cord injury.
The Best Incontinence Care Products for Older Adults
Pharmacies and/or home healthcare stores will carry a variety of helpful incontinence products. These include:
- Adult diapers. Diapers aren’t just for young children anymore! Seniors can also wear these to absorb human waste. Don’t delay too long with changing diapers. As diapers are in direct contact with the skin, human waste can lead to painful rashes and dangerous infections. Caregivers may find seniors will react better to the term “briefs”.
- Waterproof and washable bed pads. Place the pad underneath your senior’s bottom bed sheet. This will soak up any overnight urinary accidents and provide increased comfort for the senior. A waterproof bed pad will also better protect the senior’s mattress from damage or mold and reduce nasty stains and smells.
- Condom catheters. These will be for men only and are a three-part system. The first part will slide over a man’s genitals. The second part is a plastic tube which can run down the leg. The third part is a plastic bag at the bottom of the leg which collects urine. As the device can be worn comfortably underneath a pair of pants, none of this will be noticeable.
- Men’s Liberty. If a man prefers, this product can be placed over the tip of his genitals. This can provide a little more freedom and convenience to the wearer. The tight seal will prevent any risk of leakage. As with the external condom catheter, urine can flow down a plastic tube attached to a leg and into a bag.
- Bedside urinals. Seniors may have limited mobility and cannot move quickly from a bed to a bathroom. In this case, a bedside urinal can be helpful. Bedside urinals often resemble a jug or a dish. Women will find this process more difficult than men. Women can use another product that resembles a funnel with a wider opening to better "aim" urine into the jug or dish.
- Commodes. Commodes look like a standard toilet, can be placed at the bedside, and folded when not in use. Commodes greatly reduce the length of the trip required to reach the bathroom. Urine is collected in a small bowl directly underneath the seat. Incontinence management requires regular emptying and washing of this bowl
- Internal catheters. Internal catheters are inserted directly into the bladder via the urethra to drain the bladder. Users can enjoy more freedom and mobility but this does come with an increased risk for a urinary tract infection. Internal catheters can also be referred to as Foley Catheters.
12 Tips to Make Caring for Incontinence Easier for Caregivers
Incontinence care is easiest when you can prevent an accident before it happens. These tips can help:
- Go before leaving home. Family caregivers can ensure that incontinent seniors go to the bathroom before any (especially a lengthy) trip. Family caregivers may be reminded of previous family journeys when they were younger and were quizzed about going to the bathroom before getting in the car.
- Dress appropriately. When my father was alive, his care home staff recommended that my family provide him with button-up – rather than pullover – sweaters to wear. The reason was that facility care staff could dress and undress him much easier. Family caregivers can follow the same practice with their own loved ones. A senior’s wardrobe should include clothing that is both easy to wear and quick to remove (if necessary). Avoid snug-fitting clothes and/or belts. Sweat pants and clothes with Velcro fasteners are excellent alternatives.
- Map your trip. Locate the closest bathroom(s) prior to venturing out. Is the public bathroom located up or down a flight of stairs? Stairs can prove to be difficult for seniors at any time. If the caregiver is trying to rush a senior up or down steps, either person could fall and this could be dangerous. Are public washrooms accessible with a wheelchair or walker? On longer trips out, are regular rest stops available? Public bathrooms may be pay-to-use so carry some pocket change with you.
- Limit drinking. Reducing the amount of what goes in will reduce the amount of what comes out. Cut back on any drinks. Plenty of water is still encouraged to stay hydrated. Avoid caffeinated beverages as those can quickly lead to incontinence.
- Take an extra layer. Family caregivers can carry a bag with an extra pair of pants and underwear. If needed, slip into the nearest public washroom and help your parent change clothes.
- Pack an extra roll of toilet paper. Reaching a bathroom in time is only half the battle won…there may be a limited amount of toilet paper on the roll inside. Plan for this and help clean up by carrying another roll of toilet paper with you. A washcloth can also be handy.
- Exercise. Seniors can add slower and faster pelvic muscle contractions to their routine. These are often referred to as Kegel exercises. If you are interested in adding these to your daily regimen, check with your family doctor. He or she can best recommend if these exercises could be appropriate and explain the movements required.
- Show. Seniors don’t always understand verbal directions or prompts, so caregivers may be better to demonstrate the act of going to the bathroom. Caregivers may find it necessary to hold a senior’s hand, lead him/her to the bathroom, and sit on the toilet first to best demonstrate the procedure.
- Point the way. Seniors with incontinence can also be guided towards the bathroom by other means. Try leaving the bathroom light on overnight, creating directional arrows (made from glow-in-the-dark tape) for the floor, or installing a light sensor to detect movement when a senior enters the bathroom.
- Cushion the toilet seat. This simple trick can make bathroom visits more comfortable for aging seniors. Look for a cushioned seat at a local homecare supply store. The toilet seat and toilet bowl colors don’t have to match and it can be better when they don’t. A contrasting colored toilet seat will be easier for older eyes to see.
- Incorporate a routine. Habits can be appreciated by both the human body and mind, so caregivers can schedule bathroom visits for seniors at regular intervals throughout the day and overnight. More frequent bathroom visits will result in smaller – and perhaps more disappointing - outcomes, but these will be far preferable to one larger case of incontinence.
- Encourage. Do you like to be recognized for doing good work? Seniors will also appreciate and respond favorably to kind words or a pat on the back. Family caregivers could, therefore, praise a loved one for raising the alarm before an accident happens or helping in whatever manner possible.
How Do Incontinence and Alzheimer’s Disease Connect?
Incontinence and Alzheimer’s disease can occur hand-in-hand. This is easy to understand, as a senior suffering from Alzheimer’s disease may not remember the sensations of needing to go to the bathroom. Furthermore, a senior with Alzheimer’s can forget where the closest bathroom is located, what is required when entering the bathroom, or even why a bathroom exists. While a family caregiver can patiently explain the need to go to the bathroom and lead the senior into the bathroom, all can be forgotten quickly. While I did not have to deal with any incontinence with my father’s Alzheimer’s disease, there were countless times when I needed to remind him about something I had just said.
Seniors with Alzheimer’s disease have reduced strength and mobility (to sit down on and stand up from a toilet) and balance (to stand in front of a toilet). If, and when, a sudden urge to go to the bathroom strikes, a senior with Alzheimer’s disease may be slower to respond. With his worsening physical and mental health, my father lost his ability to speak so he couldn’t tell me anything – this would have included his potential need to visit the bathroom. Caregivers seeing this as well need to become detectives. Tip-offs to any senior discomfort can include fidgeting, pacing, leg-crossing, and/or grimacing.
The good news for family caregivers is that they may not have to witness or help manage senior incontinence until the later stages of Alzheimer’s disease. Scientifically, family caregivers can expect incontinence problems to occur at stage 6c of Alzheimer’s disease (when the body and brain are weaker). To learn more, please read The Seven Stages of Alzheimer's Disease.
Caregivers must take extra care with incontinent seniors with Alzheimer’s disease. This condition can cause a senior to become increasingly confused or alarmed when caregivers express anger or frustration. Please accept what has happened and remain calm.
Can You Treat Incontinence?
Incontinence care can begin with an honest discussion with your senior’s doctor. A long-term family doctor will be most familiar with your parent’s medical history, should not have to conduct an extensive number of tests, and can be trusted to provide the best solution. Testing is a two-part process consisting of a complete physical exam and providing of a urine sample. This sample will be thoroughly examined to check for any infections or diseases.
This may not point to anything conclusive. In this case, the doctor may require an x-ray or a urinalysis test. X-rays probably don't require an explanation, but a urinalysis test may need defining. This involves the patient urinating into a modified toilet. This toilet will report the speed and strength of the senior’s urine stream. The doctor will check this supplied urine for any infection. If that doesn't clear things up, the doctor will insert a catheter into the senior’s bladder and a tube into the senior’s rectum. Granted, this may not sound very comfortable, but rest assured that the senior should not experience much pain. The doctor will slowly pour saline into the catheter, gauge response, and check for any urine leakage.
Depending on the findings, your family doctor may take any number of action steps. Medications (e.g. Ditropan XL, Detrol, Enablex, and Vesicare) may be prescribed, medical devices recommended, or surgery conducted. Caregivers can make the best decision by fully exploring all the options with the doctor and their loved one.
Cleaning Up After Incontinence Incidents
Seniors may not realize that an accident has happened or try to hide the incident, so the caregiver needs to remain aware and wash up following a situation. Uncleaned human waste can soak into skin, produce painful rashes, smell, and simply be very unpleasant for the senior. Personally, I expect I would have balked if I had ever had to deal with my parents’ incontinence and expect others would feel the same way with their loved ones. Cleaning up can be unpleasant, but it needs to be done. Here are some tips to make this job easier:
Jump to action. Emergency crews respond to situations as quickly as possible for good reason. Any long delays can prove to be unsafe. Family caregivers should follow this example. Try to avoid lengthy waiting. This, understandably, will be easier to do when the caregiver and senior are at home. If they are on an outing, a private spot will have to be found.
Remove soiled undergarments and/or incontinence pads. Underwear, dependent on condition, can be tossed into a washing machine for cleaning. Using the “hot water” wash cycle will be the best. Used pads should be immediately discarded.
Wash the soiled area. A senior’s groin area will be the most obvious, but there can be other spots that need cleaning (e.g. urine may have seeped down a leg or been touched by a senior’s hand). Wear disposable gloves; use mild soap and warm water; and dry the senior thoroughly with a soft, laundered towel.
Redress the senior. Following cleaning, the senior will need replacement clothes and/or incontinence pads. If a senior can help here, or with the previously-mentioned stages, encourage him/her to do so. This will help to encourage dignity and independence.
Wash clothes. This will include any bedsheets and/or blankets. Adding white vinegar or baking soda to the wash can reduce or remove smells. As with soiled undergarments, if sheets and/or blankets are excessively damaged, it can be best to completely dispose of them.
Wash your own hands. Avoid the spread of harmful germs. Using the hottest water possible, scrub your own hands clean following this job.
As a last word, with advancing age, incontinence can – and likely will – happen in some form. My advice? Deal with incontinence care the same way you do with other caregiving issues you face – with diplomacy, sensitivity, and tact.