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The woes of incontinence

Although we don’t like to talk about it, we should. Incontinence is an almost taboo subject, but it poses a challenge for many caregivers of the elderly, physically challenged and medically disabled. So, let’s talk about it.

I am the primary caregiver for my elderly parents, who have dementia, and both have experienced some incontinence. Although this issue is common among the elderly, it does not necessarily develop simply because of aging. Incontinence is, however, more common in women over age 50, individuals who are in an advanced stage of dementia and the physically disabled. These groups are more likely to experience incontinence due to other medical conditions or ailments.

People often think of incontinence as accidental or involuntary bladder leakage. However, it also describes the condition of losing bowel control, although that is specifically called fecal incontinence. Urinary and fecal incontinence can cause shame, embarrassment and discomfort. They also can cause frustration and great challenges for caregivers.

Sometimes caregivers misunderstand the condition and frustrate those they care for with unrealistic expectations. I spent too much time questioning my parents, trying to help them figure out how the accidents occurred so they could “fix” or prevent them. I learned later during their doctor visits that they can no longer easily control what’s happening. The side effects of their dementia progression, along with other ailments, sometimes make it difficult for them to reach the bathroom fast enough.

The loss of sensation in the urinary/ reproductive area and inability to get to the toilet quickly because of dementia progression, damage to muscles due to prostate issues in men or childbirth in women and other conditions that cause mobility constraints are common causes of incontinence. In addition to shame and embarrassment, it also can contribute to loneliness and isolation.

The lifestyle changes incontinence requires can be problematic. However, the condition can be managed, although it is not likely to be completely resolved or corrected.

INCONTINENCE MANAGEMENT CAN INCLUDE THE FOLLOWING:

  • Finding and purchasing properly fitting, comfortable and convenient incontinence protection products (liners, pads, briefs, underpads, mattress covers, pillow covers, seat cushions and special garments).
  • Stocking wipes (sanitizing and personal cleansing)
  • Purchasing personal cleansing products (gentle and unscented soaps and intimate care cleansers)
  • Using odor-eliminating laundry detergent and other laundry cleaning/ sanitizing products
  • Frequently cleaning common areas

Due to her stroke several years ago, momma has developed normal pressure hydrocephalus (excess fluid build up on the brain, usually due to some type of head trauma). I am told this condition has a “triad” of classic symptoms: gait problems, urinary incontinence and mental confusion. Momma’s gait issue is hard for me to watch. Although she’s capable of walking and other physical activities with a little assistance, she struggles to get her feet moving and maintain balance. These challenges, paired with the loss of bladder control (and sometimes mental confusion), have made momma struggle with getting to the bathroom in a timely manner.

After trying different options and considering solutions (even a minimally invasive brain surgery), we have developed a routine that helps mitigate accidents. The new routine allows momma to achieve some level of independence, as we routinely schedule bathroom breaks. We safely escort her to the restroom, whether she thinks she needs to evacuate or not. Once there, she usually takes care of the rest.

HERE ARE SOME OPTIONS TO PREVENT OR REDUCE INCONTINENCE ISSUES.

  • Regularly scheduled bathroom trips (We have recently added a late- night and early morning visit to our schedule to accompany momma to the restroom. This has been a game-changer.)
  • Limited intake of beverages at night
  • Handheld urinal or portable toilet placed nearby
  • Surgically implanted device for bladder control
  • Electrical stimulation to increase bladder control
  • Self-installed catheters
  • Controlling foods and beverages that trigger issues
  • Increasing fiber intake
  • Carrying a personal bag of supplies when leaving home (cleansing wipes, extra incontinence briefs/liners/pads and a change of clothes)Clothing that can be removed quickly and easily.

It’s very important to be respectful while dealing with incontinent individuals to help them maintain a sense of pride, dignity and independence. However, don’t enable laziness. Encourage them to actively participate in the management of their condition.

Written by Dr. Tracy Daniel-Hardy

Dr. Tracy Daniel-Hardy is the author of “The Adventures of Butch and Ruby: Chronicles of a Caregiver” and director of technology for Gulfport School District. She may be contacted at tracy@drtracydanielhardy.com.

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