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4 Helpful Tips For Caring For A Loved One With Incontinence

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Urinary or bowel incontinence is the result of weakened pelvic floor muscles causing loss of control of the bladder or bowel and leading to bladder control problems. This is a common occurrence in the elderly or disabled. It is even more common when dementia from Alzheimer's or neurological disturbances from Parkinson’s Disease are added to the mix.

If your loved one suffers from urinary incontinence, as well as Alzheimer's, dementia, or Parkinson’s Disease, they may forget how to manage and control their bodily functions or lose the ability to do so over time.


Any sudden loss of continence should be evaluated by a physician for possible infection or other complications. If there is ever a drastic change in confusion, dementia, or other behavior at any time, a physician should be consulted as urinary infection may be a culprit with or without changes in continence.


What Causes Incontinence?

Chronic diseases or medical conditions can increase the possibility of incontinence such as diabetes, kidney disease, and an enlarged prostate. The probability of urinary incontinence in women also increases after menopause with the number of children a woman has given birth to.

Muscle tone decreases with age and sphincter and rectal muscles are among some of the first to become weakened and atrophied. Pelvic floor exercises and Kegel exercises can help, but in the case of dementia, it can be difficult to teach or manage and urine leakage may still occur.

Other types of urinary incontinence include: 

  • An overactive bladder (OAB

  • Stress incontinence that accompanies incontinence symptoms with sneezing or coughing 

  • Waiting too long before emptying the bowel or bladder

  • Issues such as constipation or urinary tract infection

For men, urinary incontinence can also be caused by obstruction due to an enlarged prostate gland. For women, urinary incontinence can be caused by a prolapsed pelvic organ such as the uterus or rectum

Initially, the obstruction causes retention of urine until the bladder becomes stretched and enlarged and it begins to overflow and leak or with a change of position, spontaneously squirt out a large amount of urine.  If the urine doesn’t leak out, the bladder can become enlarged and at risk for rupture. 

Urinary retention is dangerous because the urine can become infected easily and the infection can quickly spread to the kidneys and result in sepsis. 

4 Tips To Follow When Caring For A Senior With Incontinence

 

1. Start A Routine Toileting Habit With Your Loved One

One of the best ways to start to deal with incontinence is to make simple lifestyle changes, such as routinely toileting every two hours while awake. This promotes bladder training and bowel management. 

Set a timer or alarm on a watch or clock and take your loved one to the bathroom and try to help them urinate or have a bowel movement every two hours. 

Emptying the bowel may only be a once-a-day process or even stretch to every other or every third day safely. However, with adequate hydration and kidney function, the bladder should have some amount of urine to be emptied each time. Continue this routine to maintain the best level of continence possible.

2. Encourage Them To Practice Kegel Exercises

While producing a stream of urine, this can be a good time to encourage your loved one to practice Kegel exercises by stopping and restarting the flow of the urine. These muscle exercises provide good feedback as to the effectiveness of Kegels and the ability to make those pelvic muscles and bladder muscles work.

By developing this new habit, the brain learns to manage incontinence better. Over a couple of weeks, it will become second nature for your loved one and become even more effective. 

As a side point, it can also be an effective means of preventing falls.  The urge to go to the bathroom can be overwhelming and cause your loved one to ignore better judgment about their ability to stand and ambulate safely. It can also encourage them to rush and throw caution and safety out the window.

Even if your loved one has dementia or other issues that may interfere with the effectiveness of their new toileting habit, the brain will absorb some of the routine procedures and become somewhat rote which will help to improve bladder and control even the smallest measure.

3. Invest In Incontinence Products

At night, and in between routine toileting, there are a large variety of incontinence products to assist in managing the incontinence of urine and feces. 

Adult Diapers, Pull-Ups, & Incontinence Underwear

Adult diapers, pull-ups, and incontinence underwear come in a wide variety of sizes and absorbency. There are also a large array of incontinence pads and underwear liners to help catch smaller amounts of leakage

The well-known blue Chuck’s disposable pads or incontinence pads can be used to protect bedding, chairs, wheelchairs, etc., from further overflow incontinence.

Catheter

For more protection from urine leaks, a catheter may be required or preferred.

Catheters can be either external for males or internal for both males and females. The internal catheter is inserted through the urethra and into the bladder. These devices are all connected to collection tubes that deposit the urine into a bag or bottle. 

A catheter bag can be a smaller leg bag that holds about a quart of urine or a night bag that can hold about 2000cc. The collection devices need to be emptied at least every 8 hours following specific directions to not leave the system open and vulnerable to air and bacteria.

4. Ensure You and Your Loved One Practices Regular Hygiene 

Hygiene with each of these incontinence-related products is a necessity to prevent infection and skin irritation. 

For example, with an internal catheter, it is vitally important to maintain a clean and closed system. Don’t disconnect it from the collection tubing. 

    • The catheter comes already packaged from the manufacturer in a sterile container for the doctor or nurse to insert using sterile gloves and drape pads. 

    • A doctor or nurse will insert the catheter and attach the collection tubing. 

      • A home health nurse can change the catheter in the home. The nurse removes the old one and inserts a new sterile catheter. This is usually every 4-6 weeks unless it becomes clogged, or falls out. It is rare for family members or other caregivers to be taught to change a catheter because of the possibility of infection. 

    • This system should be kept closed unless otherwise instructed by the doctor or nurse. 

    • Always wash hands before and after handling any part of the catheter. The catheter is emptied at the bottom of the collection bag only. A clean bucket or pan can be used to collect the urine. Dispose of it in the toilet. 

    • Do not allow the bag to be placed on the bed, or on the floor. It needs gravity to empty fully and being on the bed is too high. The floor can cause contamination. 

    • Don’t allow the tubing to become kinked or flattened. This can stop the free flow of urine and cause leaking. It can also be uncomfortable for your loved one. 

    • Cleanse the genitalia with warm soapy water and rinse well. The catheter must be cleaned with soap and water all along the catheter tubing from the genitalia to the start of the collection tubing.

      • Rinse well. This must be done after any bowel movement, during daily bathing, and as needed to prevent the growth of bacteria. The catheter is not fixed in place and can move in and out of the urethra by up to an inch so the entire tube must be kept clean. The collection tubing and bag can also be washed with soap and water.

    • Be very careful not to tug or pull on the catheter when moving, transferring, or walking. It is kept in place inside the bladder by a small balloon inflated with sterile water. If it is tugged on or pulled hard, it can be dislodged. This is very painful and can cause damage to tissue. 

Long-term use of internal catheters is not recommended due to the vulnerability to infection.


How To Help Your Loved One Manage Incontinence?

Managing incontinence issues can be complex. 

For males with an enlarged prostate, an internal catheter may be prescribed by a urologist as necessary to allow for the normal flow of urine. Insertion can be painful and may require a special catheter with a harder tip that is curved to allow it to pass around the prostate. Eventually, surgical removal of the prostate may be necessary. 

For females, a device called a pessary can be fitted by a urologist or urogynecologist. The pessary is inserted into the vagina to hold up the prolapsed uterus or rectum. These pessaries need to be removed every 4 to 6 weeks, cleaned, and then reinserted. 

Home health care nurses can routinely change pessaries in the home, but they might need help from a urology expert, such as a urologist or urogynecologist if they are too complicated to change.

There is a newer system known as a PureWick for females which is like a large banana-shaped pad that fits between the legs and attaches to a collection tube and container to catch urine. 

Other treatment options available for urinary or bowel incontinence include:

  • Medications for overactive bladder issues 

  • Nerve stimulation treatments to help restore bladder sensation and control 

  • Physical therapy treatments for strengthening pelvic floor muscles

  • Post-menopausal medications such as estrogen and progesterone 

  • Biofeedback for advanced Kegels and pelvic floor exercises

Managing the symptoms and preventing complications from chronic diseases such as diabetes, MS, Parkinson’s, kidney disease, and Alzheimer’s can also help with managing incontinence.

Caregivers are advised to pay attention to their own health issues and seek treatment to reduce risk factors for incontinence as they age. 

There are many more possibilities to effectively prevent, treat and manage incontinence at a younger age such as seeking out a physical therapist to learn techniques to strengthen the pelvic floor, early surgical repair of prolapsed organs with a sling procedure, or removal of an enlarged prostate

Simple things such as routine voiding and not holding in urine for a long time can help avoid issues such as weakened bladder and sphincter muscles, urinary infections and stress urinary incontinence.



Medical Advice Disclaimer

DISCLAIMER: ALL INFORMATION AND MATERIALS ON THIS WEBSITE ARE INTENDED FOR INFORMATIONAL PURPOSES ONLY. 

The information on this website, including text, graphics, images, and other materials, is intended for informational purposes only. No material on this webpage or any other page on this website is meant to be a substitute for professional medical advice, diagnosis, or treatment. For questions regarding medical conditions or the diagnosis and treatment of medical conditions, always seek the advice of a qualified healthcare professional or physician. Do not delay seeking nor disregard professional medical advice because of the information on this website.

Kathy Quan

Kathy Quan is a Registered Nurse with 40+ years of experience, focusing primarily on home health and hospice care in a variety of roles from Field Nurse to management. She has also written several books and blogs for healthcare professionals and caregivers. In addition, she teaches online courses for nurses and caregivers.

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