Alzheimer’s disease is a progressive illness of the brain that gradually destroys a person’s cognitive capabilities and, eventually, interferes with the performance of basic daily self-care functions. People in the latter stages of Alzheimer’s tend to experience incontinence, which is loss of control of either the bladder or bowels, or both. However, not everyone who has the disease will become incontinent.
The relationship between Alzheimer’s disease and incontinence is complex. Alzheimer’s may cause incontinence by taking away a person’s ability to recognize the need to go to the bathroom. However, Alzheimer’s also can be an indirect cause, by posing issues of mobility or confusion that may prevent the Alzheimer’s sufferer from reaching a bathroom in time. Furthermore, a person with Alzheimer’s can have incontinence issues arising from medical causes that might be independent of Alzheimer’s, such as a urinary tract infection, weak pelvic muscles, an enlarged prostate gland, or the side effects of certain medicines, to cite just a few. The Alzheimer’s Association offers a more comprehensive discussion of the possible causes of incontinence among persons with Alzheimer’s here.
When an Alzheimer’s patient begins to experience incontinence, the most important step to take is to consult his or her doctor for an evaluation of the cause. If the incontinence is a result of a problem unrelated to Alzheimer’s, it may be possible to address the issue with medical intervention. If a medication is contributing to incontinence, as might be the case, for example, with some anti-anxiety drugs and sleep aids that relax the bladder muscles, a substitute medicine might be available. In all cases, however, here are some actions that a caregiver or the incontinence sufferer should consider taking to reduce the potential incidence of incontinence:
Reduce consumption of diuretic liquids. Caffeine is a diuretic, which means it stimulates urination. Consumption of liquids that contain caffeine, such as most coffees, teas and colas, should be restricted or perhaps avoided entirely, especially close to bedtime. Alcohol also has a diuretic effect. However, medical authorities warn against restricting the intake of water. Staying properly hydrated is extremely important.
Simplify bathroom access. Whether from the Alzheimer’s patient’s bed or from the easy chair where he or she watches TV, make the route to the bathroom simple and free of obstruction. Be sure no furniture blocks any portion of the journey, and no area rugs pose any hazards. Avoid clutter in the bathroom itself. Keep the route(s) illuminated with low-wattage nightlights after dark. It also may be advisable to keep the bathroom light on all night.
Avoid cumbersome clothing. Clothing should be loose fitting and allow quick access to underwear, which should easily slip on and off. Keep in mind that a late-stage Alzheimer’s patient is likely to have poor coordination and can easily get confused by such items as buttons and clasps.
Make bathroom breaks routine. Encourage frequent trips to the bathroom, even when the need is not urgent. It will help reduce “emergency” situations.
Maintain dignity. Even the mere prospect of incontinence can create a trying experience for both Alzheimer’s patient and caregiver. When assisting the patient, allow him or her the greatest amount of privacy or autonomy that is practical in any given situation. If a loss of control should occur, avoid overreaction and do not use words that are shaming, scolding or condescending. Instead, use matter-of-fact language and try to convey a sense of “accidents will happen.” Try to minimize his or her embarrassment and maintain dignity.
In addition, there are several products available that make it possible for those with incontinence to experience a higher quality of life, such as washable panties and briefs that control leakage and eliminate odor. Also, waterproof underpads and bed pads are available to protect chairs, wheelchairs, mattresses, and bedding.
Eric I. Mitchnick, MD, FACS is a Board Certified Urologist at Advanced Urology Centers of New York in Northport and Port Jefferson Station, NY. He serves as Chair of the Credentialing Committee and Surgical Performance Review Committee at Huntington Hospital. In addition, he is a fellow of the American College of Surgeons, a member of the New York chapter of the American Urological Association, and the President of the Board of Integrated Medical Foundation, an organization that promotes awareness and early detection of prostate cancer.
Dr. Mitchnick received his Bachelor of Arts degree, majoring in Natural Sciences, from Johns Hopkins University, and his MD degree from SUNY Health Science Center. He completed his four years of residency training at Beth Israel Medical Center in New York, N.Y, from 1989 – 1993. Read more about Dr. Mitchnick’s expertise and practice at http://www.aucofny.com/eric-i-mitchnick-md-facs/.
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